EP14.15: Comparison of perinatal outcomes of MCDA twin pregnancies complicated by selective fetal growth restriction following interstitial LASER ablation in a tertiary fetal care centre

To assess the efficacy of selective fetal reduction by interstitial laser in MC twin pregnancies complicated by sFGR (selective fetal growth restriction). This is a retrospective study of monochorionic [MC] twin pregnancies with sFGR from 2010-2023 at a tertiary fetal care centre in South India. sFGR is defined as per the Delphi consensus criterias. FGR fetuses classified into 3 types based on UA Doppler flow. Interstitial LASER performed selectively in impending death cases, under local anesthesia and USG guidance by 2 senior experts. In 31 pregnancies, majority had Twin–twin transfusion syndrome (TTTS) requiring intervention. Compared to 52 pregnancies with sFGR and additional monochorionic complications but no intervention. Primary outcomes: single survivors and double losses. Overall, single survivors were 10/52 (19.2%) and 42/52 (80.8%) miscarried. Our study confirms the benefit of performing interstitial LASER to reduce the growth restricted baby in MC pregnancies complicated by sFGR with TTTS. The single survival rate in the intervention group was significantly higher than the non-intervention group. We recommend that when sFGR is complicated by additional findings of TTTS, parents must be counselled about the further increase in the double and single loss rate and hence offer intervention to reduce the smaller twin.