Pregnancy loss after intrauterine surgical treatment of twin-to-twin transfusion syndrome
Gladkova K.A., Sakalo V.А.
Background: The most common indication for intrauterine surgery is the fetoscopic laser coagulation (FLC) of placental anastomoses in twin-twin transfusion syndrome (TTTS). TTTS is a complication of monochorionic multiple pregnancy characterized by high perinatal and neonatal morbidity and mortality caused in most cases by preterm birth. FLC has been shown to be more beneficial than amnioreduction and is therefore the current standard of care for the treatment of TTTS. Fetoscopic coagulation is characterized by a postoperative survival rate of both fetuses of almost 90% and is associated with a high incidence of premature rupture of membranes and subsequent termination of pregnancy.
Objective: To analyze the association of preoperative cervical length shortening and its correction with termination of pregnancy in women with monochorionic twins after intrauterine TTTS surgical treatment.
Materials and methods: This was a retrospective cohort study with the analysis of postoperative termination of pregnancy and preterm labor in patients with monochorionic twins complicated by TTTS. The study included 450 pregnant women with monochorionic diamniotic twins. All of them underwent FLC for TTTS at the National Medical Research Centre for Obstetrics, Gynecology and Perinatology in Moscow from January 2013 to January 2024. Group I (n=345) consisted of patients with preoperative cervical length ≥3 cm, group II (n=104) included patients with cervical length <3 cm, one patient was excluded from the study. Depending on the methods of cervical shortening correction, group II was divided into subgroups: subgroup 1 (n=53) had pessary, subgroup 2 (n=51) had cervical cerclage. FLC was performed in 440 cases, namely, in patients with I-IV stages of TTTS. Nine pregnant women received intrauterine treatment of TTTS stage V as transabdominal cordocentesis, intrauterine transfusion of erythrocyte mass to the surviving fetus with severe anemia.
Results: No statistically significant increase in the frequency of pregnancy loss was found in patients with correction of cervical shortening. Spontaneous pregnancy loss within seven days after surgery occurred in 17 (4.9%) patients of group I and in 6 (5.8%) patients of group II. The median term of delivery was 31.8 and 32 weeks in the study groups (p=0.281 and p=0.330, respectively). In the group of patients with cervical shortening, premature rupture of membranes was statistically significantly more frequent (p<0.05), regardless of the correction method.
Conclusion: No correlation between cervical length shortening, methods of correction and adverse pregnancy outcomes was found in our study.
Authors’ contributions: Gladkova K.A. – developing the concept and design of the study, review of publications, structural organization, writing the text; Sakalo V.A. – collection of material, analysis and statistical processing of the data, writing the text.
Conflicts of interest: The authors declare that there are no conflicts of interest.
Funding: The study was carried out without sponsorship.
Ethical Approval: The study was approved by the Ethical Review Board of the Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia.
Patient Consent for Publication: The patients signed informed consent for the publication of their data.
Authors' Data Sharing Statement: The data supporting the findings of this study are available on request from the corresponding author after approval from the principal investigator.
For citation: Gladkova K.A., Sakalo V.А. Pregnancy loss after
intrauterine surgical treatment of twin-to-twin transfusion syndrome.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2024; (12): 26-32 (in Russian)
https://dx.doi.org/10.18565/aig.2024.245
Keywords
monochorionic pregnancy
twins
twin-twin transfusion syndrome
fetoscopic laser coagulation of placental vascular anastomoses
preterm labor
cervical shortening
pessary
cerclage
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Received 07.10.2024
Accepted 25.11.2024
About the Authors
Kristina A. Gladkova, PhD, Senior Researcher at the Fetal Medicine Unit, Institute of Obstetrics, Head of the 1st Obstetric Department of Pregnancy Pathology, V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia, 117997, Russia Moscow, Ac. Oparin str., 4, +7(916)321-10-07, k_gladkova@oparina4.ru,https://orcid.org/0000-0001-8131-4682
Viktoriya A. Sakalo, PhD, Researcher of the Fetal Medicine Unit, Institute of Obstetrics, obstetrician-gynecologist at the 1st Obstetric Department of Pregnancy Pathology, V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia, 117997, Russia Moscow, Ac. Oparin str., 4, +7(929)588-72-08, v_sakalo@oparina4.ru,
https://orcid.org/0000-0002-5870-4655
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