A Prospective Study of Systematic Postpartum Placental Examination After Fetoscopic Laser Surgery for Twin-to-Twin Transfusion Syndrome: Residual Anastomoses and Clinical Outcomes.

OBJECTIVE

The present study aimed to assess the technical completeness of fetoscopic laser coagulation (FLC) in monochorionic diamniotic (MCDA) twin pregnancies complicated by twin-to-twin transfusion syndrome (TTTS) using systematic postpartum placental dye injection, to identify residual placental vascular anastomoses, and to examine their relationships with perinatal outcomes.

METHODS

Twenty MCDA twin pregnancies treated with FLC for TTTS were prospectively evaluated. Postpartum placentas were examined using systematic colored dye injection via both umbilical cords to assess residual vascular anastomoses. Placental findings were evaluated in relation to operative characteristics and perinatal outcomes.

RESULTS

No macroscopically detectable residual anastomoses were identified in the 8 cases in which Solomonization was performed, whereas residual anastomoses were detected in 5 of the remaining 12 cases. In total, seven residual anastomoses were identified, including six arteriovenous and one arterioarterial anastomosis. Four of the five placentas with residual anastomoses were anteriorly located. Among cases with residual anastomoses, postoperative follow-up revealed TAPS in two cases, persistent TTTS in one, single IUFD in one, and double IUFD in one.

CONCLUSION

Systematic postpartum placental dye injection provides a valuable quality-assessment approach for evaluating the anatomical outcome and technical completeness of FLC. In this selected cohort, beyond aligning with existing literature regarding the presence of residual anastomoses in cases without Solomonization, systematic postpartum placental dye injection provides comprehensive insights into placental vascular architecture while offering valuable post-hoc validation of both the interventional procedures and clinical outcomes in MCDA twin pregnancies. Larger studies incorporating more detailed placental assessment are needed to clarify the clinical significance and determinants of residual anastomoses.