Obstet Gynecol Sci.  2023 Sep;66(5):385-394. 10.5468/ogs.23111.

Feasibility of fetoscopic laser coagulation in triplet pregnancy

• Hong YM
• Won HS
• Lee AH
• Lee MY

• KMID: 2545885
• DOI: http://doi.org/10.5468/ogs.23111

Abstract

Objective
To report the experiences of triplet pregnancies complicated by twin-to-twin transfusion syndrome (TTTS) treated with fetoscopic laser coagulation at a single center.
Methods
Herein, we conducted a retrospective analysis to investigate the management and perinatal outcomes of triplet pregnancies with TTTS treated at a single institution between 2017 and 2022.
Results
Seven of the 98 triplet pregnancies (7.1%) encountered were complicated by TTTS, and all were dichorionic triamniotic triplets. Of the seven triplet pregnancies complicated by TTTS, four were treated with fetoscopic laser coagulation at our center, at a median gestational age of 20 weeks. No procedure-related complications or maternal complications were observed. The survival rate was higher and perinatal outcomes were better in fetoscopic laser coagulation cases than in other management cases. Four donor and four recipient triplets survived, with a median gestational age of 33 weeks at delivery. Although there were no cases of poor neonatal outcomes, one case was diagnosed with white matter injury, suspected to be hypoxic-ischemic encephalopathy on postnatal investigation.
Conclusion
Fetoscopic laser coagulation is a feasible treatment option for triplet TTTS, provided the attending specialists have extensive experience with this technique.

Keyword

Fetoscopic surgery; Pregnancy outcome; Prenatal ultrasonography; Triplets; Twin-to-twin transfusion syndrome

Figure

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  Fig. 1 Flowchart illustrating the survival and management of chorionicity and amnionicity in triplet pregnancy. In our center, 7 of 98 triplet pregnancies (7.1%) were complicated by TTTS, and all were DCTA triplets. During the study period, four dichorionic triamniotic triplets underwent FLC at our center. MCTA, monochorionic-triamniotic; DCTA, dichorionic-triamniotic; TCTA, trichorionic-triamniotic; SFR, selective fetal reduction; FDIU, fetal death in utero; TTTS, twin to twin transfusion syndrome; FCL, fetoscopic laser coagulation; RFA, radiofrequency ablation.

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  Fig. 2 Photographs of the delivered placenta. There were no residual anastomoses between the recipient (fetus B) and donor (fetus C) in case no. 3. The territory of monochorionic placenta was successfully complete dichorionized by fetoscopic laser coagulation.

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  Fig. 3 Brain images the recipient of case no. 1 with a complicated cerebral injury. (A) Antenatal sonographic image at gestational age 28 weeks showing normal structures. (B) Postnatal sonographic image at 4 days of age showing multifocal echogenic foci (arrow) at the bilateral periventricular white matter, indicating white matter injury such as hypoxic-ischemic encephalopathy. (C) Postnatal brain magnetic resonance imaging at 1 month of age showing punctate white matter frontoparietal lesions (arrow) with hemorrhage showing as dark signal intensity on susceptibility weighted imaging.

Reference

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