Fetal heart rate changes associated with sequential selective laser surgery for twin-twin transfusion syndrome.

ABSTRACT

OBJECTIVE: To investigate perioperative changes in fetal heart rate (FHR) associated with sequential vs standard selective laser photocoagulation of communicating vessels for the treatment of twin-twin transfusion syndrome (TTTS). STUDY DESIGN: Women with TTTS were treated with the intent of using the sequential procedure. Those who failed this treatment were categorized as having undergone the standard procedure. Pre- and postoperative FHR of donor and recipient fetuses were analyzed. RESULT: Of 98 women, 35 received the standard technique. A postoperative drop in the mean donor FHR was observed in gestations receiving the standard laser, but not in those receiving the sequential technique. In multivariable models that included operative and gestational characteristics, the use of the sequential treatment was associated with improved stability of the FHR of the donor twin. CONCLUSION: The stability in donor FHR following sequential laser ablation when compared with the standard technique is consistent with improved donor hemodynamics.