Fetoscopic Laser Surgery for Complicated Monochorionic Twin Pregnancies in Mothers Living with HIV: Case Series

Evidence on fetal surgery in mothers living with HIV is limited. All intrauterine invasive procedures carry a risk of fetal exposure to maternal blood, and therefore, a theoretical risk of vertical transmission must be considered. Currently, there is no published data on fetoscopic procedures in mothers living with HIV.

We present a multicenter case series of three monochorionic diamniotic twin pregnancies in mothers living with HIV, all complicated by twin-to-twin transfusion syndrome and treated with fetoscopic laser surgery. The procedures were performed between 18.4 and 23.0 weeks of gestation, and all patients were receiving effective combination antiretroviral therapy. At the time of fetal surgery, maternal viral load was 52 copies/mL in two cases and <50 copies/mL in the remaining case. Prophylactic intraoperative zidovudine was administered in one of the two cases with a viral load of 52 copies/mL. At the time of delivery, none of the patients received intrapartum zidovudine prophylaxis, as viral loads were <50 copies/mL in all cases. Deliveries occurred between 29.0 and 37.6 weeks of gestation, including both cesarean and vaginal deliveries. Neonatal antiretroviral prophylaxis was administered in all cases, and postnatal follow-up revealed no evidence of vertical transmission.

Fetoscopic laser surgery for complicated monochorionic twin pregnancies in mothers living with HIV receiving effective antiretroviral therapy and having undetectable or low viral loads appears to be safe. The theoretical risk of vertical transmission in such cases is likely negligible and should not be considered a contraindication to the procedure under optimal conditions.