Maternal hemodynamic evaluation in monochorionic twin pregnancy complicated by twin-to-twin transfusion syndrome treated with fetoscopic laser surgery.

fetoscopic laser ablation maternal hemodynamics monochorionic pregnancy twin-to-twin transfusion syndrome

Journal

American journal of obstetrics & gynecology MFM
ISSN: 2589-9333
Titre abrégé: Am J Obstet Gynecol MFM
Pays: United States
ID NLM: 101746609

Informations de publication

Date de publication:
Mar 2024
Historique:
received: 01 09 2023
revised: 08 12 2023
accepted: 20 12 2023
pubmed: 26 12 2023
medline: 26 12 2023
entrez: 25 12 2023
Statut: ppublish

Résumé

Maternal cardiovascular adaptations are amplified in twin pregnancies to support the metabolic request of the feto-placental unit. Few studies have evaluated the maternal hemodynamics changes after routine use of laser surgery in the treatment of twin-twin transfusion syndrome. The aim of our study was to evaluate hemodynamic changes in monochorionic twin pregnancies complicated by twin-twin transfusion syndrome before and after treatment with fetoscopic laser surgery. A prospective observational study from 2020 to 2022, included monochorionic twin pregnancies complicated with twin-twin transfusion syndrome undergoing laser surgery between 16 and 26 weeks of gestation. To assess placental function and perfusion, uterine artery pulsatility index, hemoglobin, hematocrit, and soluble fms-like tyrosine kinase-1/placental growth factor ratio sampling prelaser and 24 hours postlaser were measured. Echocardiography by a single cardiologist evaluated maternal hemodynamics at presurgery, 24 hours, and 1 week postlaser. Those data were crosswise compared with cardiovascular indices of uncomplicated monochorionic pregnancies recruited at the same gestational age using nonparametric tests. Moreover, we fitted random-intercept linear regression models to investigate maternal hemodynamic changes according to the amount of amniotic fluid drained during laser surgery. Forty-two twin-twin transfusion syndrome pregnancies with a median gestational age of 19.1 (17.4-20.9) weeks and 15 uncomplicated monochorionic pregnancies at the same gestational age were enrolled. Overall survival rate after laser was 72% with delivery at a median gestational age of 31.5 (27-34) weeks. Significant changes in blood chemistry and placental function were observed in the twin-twin transfusion syndrome group, along with alterations in arterial pressure, heart rate, cardiac output, and ventricular strain, eventually aligning with the uncomplicated group's values by 1 week postlaser. The amount of amniodrainage, with a 1000 ml cut-off, did not significantly impact hemodynamic parameters. Lastly, we detected a percentage of laser surgery complications in agreement with international literature and we did not record any maternal procedure-related problems. Our analysis highlighted that maternal cardiovascular status in monochorionic twin pregnancy complicated by twin-twin transfusion syndrome was more dynamic and; 1 week after fetoscopic laser ablation of placental anastomosis completed by amniodrainage, maternal hemodynamic parameters restored to values similar to uncomplicated monochorionic twin pregnancies.

Sections du résumé

BACKGROUND BACKGROUND
Maternal cardiovascular adaptations are amplified in twin pregnancies to support the metabolic request of the feto-placental unit. Few studies have evaluated the maternal hemodynamics changes after routine use of laser surgery in the treatment of twin-twin transfusion syndrome.
OBJECTIVE OBJECTIVE
The aim of our study was to evaluate hemodynamic changes in monochorionic twin pregnancies complicated by twin-twin transfusion syndrome before and after treatment with fetoscopic laser surgery.
STUDY DESIGN METHODS
A prospective observational study from 2020 to 2022, included monochorionic twin pregnancies complicated with twin-twin transfusion syndrome undergoing laser surgery between 16 and 26 weeks of gestation. To assess placental function and perfusion, uterine artery pulsatility index, hemoglobin, hematocrit, and soluble fms-like tyrosine kinase-1/placental growth factor ratio sampling prelaser and 24 hours postlaser were measured. Echocardiography by a single cardiologist evaluated maternal hemodynamics at presurgery, 24 hours, and 1 week postlaser. Those data were crosswise compared with cardiovascular indices of uncomplicated monochorionic pregnancies recruited at the same gestational age using nonparametric tests. Moreover, we fitted random-intercept linear regression models to investigate maternal hemodynamic changes according to the amount of amniotic fluid drained during laser surgery.
RESULTS RESULTS
Forty-two twin-twin transfusion syndrome pregnancies with a median gestational age of 19.1 (17.4-20.9) weeks and 15 uncomplicated monochorionic pregnancies at the same gestational age were enrolled. Overall survival rate after laser was 72% with delivery at a median gestational age of 31.5 (27-34) weeks. Significant changes in blood chemistry and placental function were observed in the twin-twin transfusion syndrome group, along with alterations in arterial pressure, heart rate, cardiac output, and ventricular strain, eventually aligning with the uncomplicated group's values by 1 week postlaser. The amount of amniodrainage, with a 1000 ml cut-off, did not significantly impact hemodynamic parameters. Lastly, we detected a percentage of laser surgery complications in agreement with international literature and we did not record any maternal procedure-related problems.
CONCLUSION CONCLUSIONS
Our analysis highlighted that maternal cardiovascular status in monochorionic twin pregnancy complicated by twin-twin transfusion syndrome was more dynamic and; 1 week after fetoscopic laser ablation of placental anastomosis completed by amniodrainage, maternal hemodynamic parameters restored to values similar to uncomplicated monochorionic twin pregnancies.

Identifiants

DOI: 10.1016/j.ajogmf.2023.101270 PMID: 38145821
pubmed: 38145821
pii: S2589-9333(23)00412-3
doi: 10.1016/j.ajogmf.2023.101270
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

101270

Informations de copyright

Copyright © 2023 Elsevier Inc. All rights reserved.

Auteurs

Roberta Milazzo (R)

Department of Woman, Mother and Neonate, Buzzi Children's Hospital, University of Milan, Milan, Italy (Drs Milazzo and Cetin).

Massimo Garbin (M)

Pediatric Cardiologic Department, Buzzi Children's Hospital, University of Milan, Milan, Italy (Drs Garbin and Mannarino).

Dario Consonni (D)

Epidemiology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy (Dr Consonni).

Daniela Casati (D)

Fetal Therapy Unit "U. Nicolini", Buzzi Children's Hospital, Department of Woman, Mother and Neonate, Buzzi Children's Hospital, University of Milan, Milan, Italy (Drs Casati, Faiola, Laoreti, and Lanna).

Stefano Faiola (S)

Fetal Therapy Unit "U. Nicolini", Buzzi Children's Hospital, Department of Woman, Mother and Neonate, Buzzi Children's Hospital, University of Milan, Milan, Italy (Drs Casati, Faiola, Laoreti, and Lanna).

Arianna Laoreti (A)

Fetal Therapy Unit "U. Nicolini", Buzzi Children's Hospital, Department of Woman, Mother and Neonate, Buzzi Children's Hospital, University of Milan, Milan, Italy (Drs Casati, Faiola, Laoreti, and Lanna).

Savina Mannarino (S)

Pediatric Cardiologic Department, Buzzi Children's Hospital, University of Milan, Milan, Italy (Drs Garbin and Mannarino).

Irene Cetin (I)

Department of Woman, Mother and Neonate, Buzzi Children's Hospital, University of Milan, Milan, Italy (Drs Milazzo and Cetin).

Mariano M Lanna (MM)

Fetal Therapy Unit "U. Nicolini", Buzzi Children's Hospital, Department of Woman, Mother and Neonate, Buzzi Children's Hospital, University of Milan, Milan, Italy (Drs Casati, Faiola, Laoreti, and Lanna). Electronic address: marianolanna12@gmail.com.

Classifications MeSH