Acute death of the recipient twin after fetoscopic laser surgery for twin-twin transfusion syndrome related to maternal hypotension and type of anesthesia during the procedure

Abstract

OBJECTIVE: To evaluate the relationship between acute recipient fetal demise following fetoscopic placental laser ablation and maternal hypotension associated with maternal anesthesia in twin-twin transfusion syndrome (TTTS). STUDY DESIGN: Between November 2006 and March 2011, all cases with TTTS that had recipient fetal demise within 24 hours of placental laser ablation were reviewed. For comparison, each case was matched for gestational age at procedure, Quintero staging of the disease and pre-operative Doppler studies with two cases that did not have acute recipient demise. The presence of maternal hypotension (defined as a decline in blood pressure of 20% from pre-operative values) and the duration of the hypotension were evaluated as possible links to acute recipient demise. RESULTS: Acute recipient demise occurred in 5.6% cases (15/267) following laser ablation. Recipient demise was associated with maternal hypotension (OR: 4.9, 95%CI: 1.3-18.7; p 0.02) and the duration of hypotension (OR: 3.33, 95% CI: 1.8-13.6; p 0.02). ROC curve analysis showed the threshold for maternal hypotension and duration of hypotension associated with recipient demise to be 20% and 35 minutes, respectively. General anesthesia was related with maternal hypotension (OR: 19.1, 95% CI: 3.9-94.1; p 0.01). The duration of surgery and anesthesia were not associated with maternal hypotension or acute recipient demise (p 0.23 and p 0.90, respectively). CONCLUSION: Acute recipient demise following fetos copic placental laser ablation for treatment of severe TTTS is associated with maternal hypotension and general anesthesia during the procedure.