Risk factors for fetomaternal bleeding after laser therapy for twin‐twin transfusion syndrome. (3rd December 2017)

• Record Type: Journal Article
• Authors: Chon, Andrew H.; Korst, Lisa M.; Grubbs, Brendan H.; Kontopoulos, Eftichia V.; Quintero, Rubén A.; Chmait, Ramen H.
• Is Part Of: Prenatal diagnosis. Volume 37:Number 12(2017)
• Page Start: 1232
• Page End: 1237
• Publication Date: 2017-12-03
• Subjects: Prenatal diagnosis -- Periodicals; Fetus -- Diseases -- Diagnosis -- Periodicals; Electronic journals; 618.32075
• DOI: 10.1002/pd.5173
• Languages: English
• ISSNs: 0197-3851

Abstract

Abstract: Objective: To quantify and assess potential risk factors for transplacental passage of fetal red blood cells (RBCs) into the maternal circulation (fetomaternal bleeding, FMB) after laser surgery for twin‐twin transfusion syndrome (TTTS). Study Design: A retrospective study of Rhesus‐D negative patients that underwent laser surgery for TTTS. Patients with and without postoperative detectable fetal RBCs on Kleihauer‐Betke (KB) testing were compared to determine risk factors for FMB. Patients were further sub‐classified into those with a FMB < 20% and ≥20% of estimated fetoplacental blood volume. Results: Of 60 studied patients, 26/60 (43%) had a positive postoperative KB test. The median fetal:adult RBC ratio was 0.00125, estimated to be a FMB volume of 6.25 mL. There were 17/26 (65%) of patients with FMB < 20% and 9/26 (35%) patients with ≥20% of the fetoplacental blood volume. Stage III‐Recipient and III‐Recipient/Donor patients were more likely to have a positive KB test (14/21 [66.7%] vs 12/39 [30.8%], OR = 4.50 [1.27–16.54], P = 0.0162). No other risk factors for FMB were apparent. Conclusions: Fetomaternal bleed appears to be a common finding after laser surgery for TTTS. TTTS Stage, particularly stage III‐Recipient and III‐Recipient/Donor, appears to be a risk factor for FMB. Abstract : What's already known about this topic? Invasive obstetrical procedures are associated with varying degrees of fetomaternal bleeding. The rate of fetomaternal bleeding after fetoscopic procedures such as laser surgery for twin‐twin transfusion syndrome is unknown. What does this study add? Fetomaternal bleeding after laser surgery for twin‐twin transfusion syndrome occurred approximately 40% of the time, with Stage III‐Recipient and III‐Recipient/Donor patients carrying the highest risk.