REVIEW  UPDATES IN GYNECOLOGICAL MINIMALLY INVASIVE APPROACH AND MEDICAL THERAPY 

Minerva Obstetrics and Gynecology 2021 April;73(2):247-52

DOI: 10.23736/S2724-606X.20.04714-0

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

Fetoscopic laser ablation in twin-to-twin transfusion syndrome: tips for counselling

Cristina PAJNO, Valentina D’AMBROSIO ✉, Rossella D’ALISA, Daniele DI MASCIO, Flaminia VENA, Sara CORNO, Lorenzo SPINIELLO, Alessandro MARTININO, Francesca MANICONE, Ludovico MUZII, Roberto BRUNELLI, Antonella GIANCOTTI

Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy

Twin-to-twin transfusion syndrome (TTTS) is a serious complication that affects approximately 10-15% of monochorionic twin pregnancies. The most important role for the development of this condition is the presence of an unbalanced flow through the inter-twin vascular anastomoses. Depending on the number, type and direction of the connecting vessels, blood can be transfused disproportionately from one twin (the donor) to the other twin (the recipient). The diagnosis is defined prenatally by ultrasound and involves of two main criteria: the presence of a monochorionic diamniotic (MCDA) pregnancy; and the presence of oligohydramnios in the donor’s sac- deep vertical pocket (DVP) 2 cm - and polyhydramnios in the recipient’s sac- DVP>8 cm. Once diagnosed, TTTS is usually graded by using the Quintero staging system, that is composed by five stages, from oligohydramnios in the donor and polyhydramnios in the recipient twin to fetal demise in one or both twins. Photocoagulation of the anastomotic vessels, usually followed by equatorial dichorionization, it has currently become the most common fetoscopic operation today and is considered as the gold standard for stage II-IV TTTS. pPROM, chorioamniotic separation and iatrogenic preterm birth are among the most common complications of fetoscopic laser ablation, and the mean gestational age at delivery after laser procedure is about 31 weeks.

KEY WORDS: Pregnancy, twin; Fetoscopy; Fetofetal transfusion