Intrauterine infection in TTTS after laser therapy: incidence, risk factors and perinatal outcome.
Case-control study for chorioamnionitis and funisitis following laser surgery for TTTS
Fetoscopic laser surgery is the first treatment choice for twin-to-twin transfusion syndrome(TTTS). Several studies have reported on the complications in pregnancies after laser therapy, including recurrent TTTS, twin anemia polycythemia sequence (TAPS), miscarriage, premature preterm ruptured of membranes (PPROM,) and fetal death. Intrauterine infection (IUI), an important complication after fetal invasive procedures, has not yet been studied extensively.
Laser surgery is associated with increased risk of iatrogenic rupture of membranes, which may subsequently lead to microbial invasive and perinatal fetal infection. Recent studies have shown that chorioamnionitis (CA) and funisitis are associated with increased risk of premature delivery, neonatal sepsis and cerebral injury.
The aim of this study is to evaluate the incidence of intrauterine infection in TTTS pregnancies treated with laser, the corresponding risk factors and perinatal outcomes. In this case control study, all TTTS cases treated with laser therapy at our center will be matched with a control group of monochorionic (MC) twins without TTTS. Measurements included histological examination of the placenta, umbilical cord and membrane and white blood cell count in both neonates. Primary outcome is the incidence of IUI in TTTS after fetoscopic laser therapy, including CA, funisitis, chronic villitis. Secondary outcomes are to indentify the risk factors of IUI in TTTS with laser therapy and to compare the outcome between recipient and donor twins.