Perinatal outcomes of monochorionic multiple pregnancies complicated by twin-to-twin transfusion syndrome


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Abstract

Relevance. Monochorionic multiple pregnancies complicated by twin-to-twin transfusion syndrome carry a high risk of perinatal morbidity and mortality. Aim. To investigate perinatal outcomes of monochorionic multiple pregnancies complicated by TTTS. Material and methods. This prospective study comprised 253 monochorionic pregnancies, including 153 pregnancies complicated by TTTS (study group) and 100 uncomplicated pregnancies (control group). The study group was divided into subgroups categorized as treated with laser coagulation of placenta anastomoses (n = 126), amnioreduction (n = 11), and having no in utero treatment of TTTS (n = 16). The groups and subgroups were compared regarding the course of the antenatal period and the neonatal outcomes. Differences were considered significant atp <0.05. Results. The antenatal death rates in patients with TTTS and control groups were 51.6% and 1%, respectively. The term of delivery in patients with and without TTTS was 31.8 and 36.0 weeks, respectively. The earliest term of delivery was observed among patients undergoing amnioreduction (29.6 weeks) and having no in utero treatment (27.1 weeks). Birthweight of newborns from pregnancies affected by TTTS was significantly lower than that from uncomplicated pregnancies. Neurological morbidity was higher among TTTS infants (26.2%) and was highest in the subgroups of amnioreduction and uncomplicated pregnancy (47.1% and 46.7%). Respiratory disorders were detected only in the study group and had the highest rates in subgroups II and III. Early neonatal mortality was noted only among newborns from pregnancies affected by TTTS (10.8%). Conclusion. Monochorionic twin pregnancies complicated by TTTS are associated with a high risk of antenatal fetal death and neonatal morbidity and mortality. Laser coagulation of placental vascular anastomoses improves perinatal outcomes in TTTS.

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About the authors

Kirill V. Kostyukov

V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology of Minzdrav of Russia

Email: kostyukov_k@yahoo.com
M.D., Ph.D., Senior Researcher at the Department of Fetal Medicine, Institute of Obstetrics, Physician at the Unit of Functional and Ultrasound Diagnostics, Department of Diagnostic Imaging

Victoria A. Sakalo

V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology of Minzdrav of Russia

Email: v_sakalo@oparina4.ru
Physician at the 1st Obstetric Department of Pathology of Pregnancy

Kristina A. Gladkova

V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology of Minzdrav of Russia

Email: k_gladkova@oparina4.ru
M.D., Ph.D., Senior Researcher at the Department of Fetal Medicine, Institute of Obstetrics, Head of the 1st Obstetric Department of Pathology of Pregnancy

Marika N. Shakaya

V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology of Minzdrav of Russia; I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia (Sechenov University)

Email: m_shakaya@oparina4.ru
Ph.D., Teaching Assistant at the Department of Neonatology, N.F. Filatov Clinical Institute of Children’s Health

Oleg V. Ionov

V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology of Minzdrav of Russia; I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia (Sechenov University)

Email: o_ionov@oparina4.ru
Ph.D., Head of the A.G. Antonov Neonatal Intensive Care Unit, Institute of Neonatology and Pediatrics

Nana K. Tetruashvili

V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology of Minzdrav of Russia

Email: n_tetruashvili@oparina4.ru
Dr.Med.Sci., Head of the 2nd Obstetrics Department of Pathology of Pregnancy

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