Síndrome de transfusión feto-feto: resultados neonatales en un hospital de tercer nivel en la Ciudad de México

Abstract

Introduction

The large majority (95%) of monochorionic-monoamniotic twins have arterio-venous placental anastomoses that allow blood to transfuse from one to the other. Without treatment, both babies are affected.

Material and methods

A retrospective analysis was performed on the outcomes of 55 monochorionic-monoamniotic twin pregnancies, complicated by twin to twin transfusion syndrome, and treated with laser coagulation in the Instituto Nacional de Perinatología (INPer) in Mexico City, from January 1999 to July 2014. Data was obtained from clinical charts. Percentages, means, and standard deviations were calculated for the descriptive analysis. The Student t-test was used to compare quantitative variables, and χ² test for qualitative ones, using SPSS v. 20 software.

Results

There were 48 live babies, 38 stillbirths, and 20 continued their treatment outside the INPer. Survival is related to the Quintero stage at the time of treatment: stage I (83%), II (35%), III (67.5%), and IV (50%). Mean gestational age at laser coagulation was 23.3 weeks. A caesarean section was used for 93.7% of the deliveries at 31.2 weeks (56 days post-treatment). The mean birth weight was 1399.8 g. There was a statistical difference in haematocrit values between donors (45 ± 10.6) and recipients (48.9 ± 11.2) (P < .001). Complications were: hydrops (4%), necrotising enterocolitis (4%), and thrombosis (2%). The main morbidities were retinopathy (14%), bronchopulmonary dysplasia (10%), and neurodevelopmental deficit (14.5%).

Conclusions

Survival and outcomes of twin to twin transfusion syndrome patients are related to the Quintero stage and gestational age. Therefore, early detection and treatment improve both prognosis and quality of life.