Short-Term Indomethacin Use Reduces Preterm Premature Rupture of Membranes After Fetoscopic Laser Surgery for Twin-to-Twin Transfusion Syndrome.

AIMS: Preterm labor is a severe problem after fetoscopic laser surgery (FLS), which often requires multiple tocolytic agents. We investigated the utility of indomethacin as a tocolytic agent after FLS.

METHODS

This study included monochorionic diamniotic twin pregnancies who underwent FLS for twin-to-twin transfusion syndrome at our hospital from 2015 to 2023. Medical records of all cases were reviewed retrospectively. Since indomethacin has been used routinely since 2020, all cases were divided into the control group (without indomethacin) and IND group (with indomethacin). Indomethacin was administered until 48 h postoperatively. This study was approved by the ethics committee of our hospital, and written informed consent for indomethacin use was obtained from all patients.

RESULTS

Fifty-seven patients were in the IND group and 97 were in the control group. No fetal adverse effects were observed in the IND group. Median gestational age at delivery did not differ between the groups (p = 0.670). pPROM within 14 days after FLS occurred more frequently in the control group (8.2%) than in the IND group (0%) (p = 0.022). The IND group had a shorter median duration of magnesium sulfate use (3 days [2-12]) than the control group (8 days [2-81]) (p < 0.001), and less frequent use of nifedipine (42% vs. 80%, p < 0.001).

CONCLUSION

The short-term administration of indomethacin was not associated with fetal adverse events, and it may be useful in postoperative management by reducing immediate postoperative pPROM and the need for other tocolytic agents.