EP14.09: Comparison of anastomoses and perinatal outcome in selective fetus growth restriction with and without Twin–twin transfusion syndrome

To investigate the differences of types of vascular anastomosis and perinatal outcomes between with selective fetus growth restriction (sFGR) with Twin–twin transfusion syndrome (TTTS) stage III or IV and sFGR type 2 or 3 without (w/o) TTTS in monochorionic-diamniotic twin pregnancies. All cases at our institution between 2007 and 2023 were included in the study. The cases without fetoscopic laser therapy (FLP) was evaluated the types of anastomoses with injected coloured dye after birth. The cases with FLP was confirmed the types of anastomoses during the procedure. A total of 48 sFGR cases were analysed (with TTTS n = 22; stage III, n = 21, stage IV n = 1, w/o TTTS n = 25; type2, n = 12: type3, n = 13). FLP was performed for 21 cases of with TTTS cases (95%) and 5 cases of w/o TTTS cases (20%). The incidence of AA anastomosis in w/o TTTS cases (95%) was higher than that in with TTTS cases (27%). The incidence of VV anastomosis in w/o TTTS cases (24%) was also higher than that in with TTTS cases (0%). At least one fetal demise was observed in 4 cases (18%) of with TTTS cases and 4 cases (16%) of w/o TTTS cases. The median of gestational weeks of delivery are 32 weeks (with TTTS cases), 33 weeks (w/o TTTS cases). Neonatal complications included Transient tachypnea of the newborn and hypoglycemia in 7 infants in with TTTS cases (performed FLP in every cases), while neonatal deaths and severe complications including cerebral palsy, periventricular leukomalacia, intestinal perforation, chorionic kidney disease and chorionic lung disease were observed in 22 infants in w/o TTTS cases (FLP performed in 1 case only). Superficial anastomoses were seen more frequently in sFGR without TTTS cases than in with TTTS cases. Severe neonatal complications tended to be more in without TTTS cases (observed without FLP) than in with TTTS cases (after FLP), although there was no difference in the incidence of fetal demise and gestational weeks of delivery.