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Prenat Diagn. 2017 Dec;37(12):1232-1237. doi: 10.1002/pd.5173. Epub 2017 Dec 3.

Risk factors for fetomaternal bleeding after laser therapy for twin-twin transfusion syndrome.

Author information

1
Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
2
Childbirth Research Associates, North Hollywood, CA, USA.
3
Wertheim School of Medicine, Florida International University, Miami, FL, USA.

Abstract

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.

PMID:
29071724
DOI:
10.1002/pd.5173
[Indexed for MEDLINE]

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