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Risk factors for fetomaternal bleeding after laser therapy for twin‐twin transfusion syndrome
Author(s) -
Chon Andrew H.,
Korst Lisa M.,
Grubbs Brendan H.,
Kontopoulos Eftichia V.,
Quintero Rubén A.,
Chmait Ramen H.
Publication year - 2017
Publication title -
prenatal diagnosis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.956
H-Index - 97
eISSN - 1097-0223
pISSN - 0197-3851
DOI - 10.1002/pd.5173
Subject(s) - medicine , fetus , bleed , laser surgery , twin twin transfusion syndrome , laser coagulation , blood volume , obstetrics , surgery , pregnancy , laser , biology , genetics , physics , visual acuity , optics
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.