[Effect on maternal blood dilution of fetoscopic laser occlusion of chorioangiopagous vessels in treating twin to twin transfusion syndrome].

OBJECTIVE

To evaluate the effect on maternal blood dilution of fetoscopic laser occlusion of chorioangiopagous vessels (FLOC) in treating twin to twin transfusion syndrome (TTTS).

METHODS

The clinical data of 71 cases of TTTS who had FLOC in Peking University Third Hospital were reviewed. Fluid intake, blood pressure, heart rate, red blood cell count, hemoglobin and hematocrit in perioperative 24 hours were analyzed.

RESULTS

(1) According to the Quintero staging, 9 cases were stage Ⅰ, 24 were stage Ⅱ, 28 were stage Ⅲ and 10 cases were stage Ⅳ. (2) The average operation time of FLOC was (64.0±16.3) minutes. One case had placental abruption after the procedure; one had placental vessel rupture and 6 women refused to take blood counting. These 8 cases were excluded and 63 cases were included in the study. (3) The perioperative bleeding volume was 3 (1, 5) ml, and the volume of fluid intake, urine, amniotic fluid drainage and net fluid intake in the perioperative 24 hours was 2 050 ml(1 530 ml, 3 700 ml), 2 300 ml (1 100 ml, 3 500 ml), 1 900 ml (1 400 ml, 2 700 ml) and -1 760 ml (-100 ml, -3 350 ml), respectively. There was no significant difference between maternal blood pressure or heart rate preoperatively and postoperatively. (4) The maternal red blood cell count [(3.47±0.36)×10(12)/L versus (3.01± 0.37)×10(12)/L, P=0.000], hemoglobin [(107.8±12.1) g/L versus (95.1±11.2) g/L, P=0.000] and hematocrit [0.313(0.238, 0.387) versus 0.276(0.213, 0.800), P=0.000] decreased significantly 24 hours after FLOC. (5) The postoperative hematocrit decreased more in the group which the amniotic fluid drainage volume was 2 000-3 000 ml than that in the group which the amniotic fluid drainage volume was 1 000-1 999 ml.

CONCLUSIONS

The blood dilution can not be ignored after the FLOC in TTTS patients. The more the amniodrainage volume during the FLOC, the more the maternal blood dilution would be. It might result from amniodrainage during the FLOC, improved maternal-placenta circulation and tocolytics used after FLOC. More attention should be take about maternal cardiac function and complications related with anemia after FLOC.