Prediction of single fetal demise after laser therapy for XXXX .

@entity1503 @entity254 @entity5617 @entity14244
OBJECTIVE: @entity5617 ( @entity5617 ) occurs in up to 20% of monochorionic pregnancies treated with laser for @entity14244 ( @entity14244 ). We aimed to determine independent factors associated with @entity5617 , to improve outcome in future care. METHODS: A case control study was performed. Data on ultrasound, laser surgery and outcome of all twin pregnancies treated for @entity14244 between 2007 and 2013 were retrieved from our monochorionic twin database. We analyzed cases of @entity5617 of donor and recipient twins separately, and compared them with treated pregnancies with two live-births. RESULTS: Out of 273 @entity14244 pregnancies treated with laser, @entity5617 occurred in 30 donors (11%) and 27 recipients (10%). In 67% @entity5617 occurred within a week after laser. In donors, absent/reversed end diastolic flow in the umbilical artery (OR 3, 95% CI 1.1-8) was the strongest predictor, followed by the presence of an arterio-arterial @entity254 (OR 4.2, 95% CI 1.4-13.1) and estimated fetal weight discordance (OR 1.04, 95% CI 1.0-1.1). In recipients, predictors were absent/reversed A-wave in the ductus venosus (OR 4.2, 95% CI 5.2-17) and the absence of recipient-to-donor arterio-venous anastomoses (OR 31, 95% CI 2.5-392.5). CONCLUSIONS: Our findings confirm earlier reports suggesting that @entity1503 is associated with @entity5617 after laser for @entity14244 . The association with type of anastomoses on @entity5617 is a new finding. We speculate that the type of anastomoses determines the degree of hemodynamic changes during laser therapy. Future strategies should aim to stabilize fetal circulation before laser, to decrease the vulnerability for acute pre- and afterload changes.
