OC81: Selective intrauterine growth restriction in monochorionics with intermittent absent/reverse diastolic flow: laser treatment vs elective delivery at 32 weeks

Abstract

Oral communication abstractsMethods: Eight early (< 17 wks), and 3 late (> 26 wks) cases were identified. Results: In EARLY cases, mean age at laser was 16.4 (14.8-16.9) wks. Maximum liquor pocket (MVP) in the recipient (R) was 8.2 (7.0-9.0) cm. Donor (D) bladder was small in 3 and empty in 5. Recipient bladder was large in 3, moderate size in 4, normal in 1. No fetus had systolic dysfunction, but 3 recipients had diastolic cardiac dysfunction. One was stage IV, 5 stage III, 2 stage II. Endoscopy time was 62 mins, laser time 42 mins; all had remifentanyl. Mean number of major anastomoses was 6.6 (2-11), mean amnioreduction was 920 (+610 to 2650) mL. There were no stillbirths (SB) or early neonatal deaths (NND); one late NND occurred in a donor. Delivery was at 32.1 (27.5-36) wks and mean latent interval was 16.2 (11-19.6) wks.; 6/8 were delivered vaginally. In LATE cases, mean age at laser was 26.7 (26.0-27.7) wks. Recipient MVP was 12.4 (9.0-14.3) cm. Donor's bladders were empty and recipient's distended in all cases. One recipient had systolic, and one diastolic cardiac dysfunction. Two were stage IV, one stage III. Endoscopy time was 61 mins, laser time 28 mins. Mean number of major anastomoses was 11.7 (11-12), mean amnioreduction was 1600 (800-2700) mL. There were 2 SB (1 donor, 1 recipient) but no NND. Delivery was at 33.3 (26.4-37) wks, and mean latent interval was 6.6 (0.4-10.6) wks.; 2/3 were delivered vaginally. Conclusion: We propose a role for laser therapy for TTTS beyond conventional gestational age guidelines. Diagnostic US criteria for TTTS must be modified in very early cases. The latent interval in very early cases is significanly longer than in our other laser cases (16.2 : 10.1 wks), and survival in this small series of very early TTTS was 95%. We suggest that laser may be a reasonable therapeutic option even > 26 wks, especially when the alternative is the delivery of a sick hydropic baby.