Evaluation of the measurement of the middle cerebral artery peak systolic velocity before and after placental laser coagulation in twin-to-twin transfusion syndrome.

OBJECTIVE

The aim of this study is to evaluate the incidence of elevated middle cerebral artery peak systolic velocity (MCA-PSV) in twin-to-twin transfusion syndrome (TTTS) before and after laser and its predictive value for intrauterine fetal death (IUFD) occurring within 2 to 7 days following laser.

METHOD: This is a 5-year retrospective single-center study on 86 consecutive laser procedures for TTTS. MCA-PSV was measured prior to and 48 h following laser. We correlated perioperative MCA-PSV and fetal survival within 7 days following laser.

RESULTS

The incidence of elevated MCA-PSV prior to and following laser (NS) was 8.2% to 9.7% (non significant (NS)). There was no correlation between the incidence of an elevated MCA-PSV prior to laser and fetal survival up to 7 days after laser (NS, χ(2) :3.49). In contrast, the presence of an MCA-PSV above 1.5 MoM 48 h following laser in the former donor puts the former donor at a higher risk for IUFD within a week after surgery [odds ratio (OR):3.42 (interval of confidence (IC) 95%:1.9-30.6), χ(2) :8.68, p < 0.003].

CONCLUSION

The occurrence of an elevated MCA-PSV following laser is related to postoperative donor death within 2 to 7 days after laser.