(829) Predictors of Placental Abruption in Fetoscopic Laser Photocoagulation for Twin-to-Twin Transfusion Syndrome

Twin-to-twin transfusion syndrome (TTTS) affects monochorionic twin pregnancies and is managed with fetoscopic laser photocoagulation (FLP), the standard of care. While FLP improves outcomes, it may be associated with complications, including placental abruption. This study aimed to identify clinical and operative predictors of placental abruption following FLP in cases of TTTS.

 

Study Design:
This retrospective cohort study included monochorionic twin pregnancies that underwent FLP for TTTS at a single tertiary fetal center between 2012 and 2024. Patients were stratified by the clinical suspicion of placental abruption. Demographic, intraoperative, and postoperative characteristics were compared between study groups. Multivariate logistic regression was used to find the association between abruption and placental location, pre-operative cervical length, gestational age at surgery, operative factors (cannula size, laser energy, laser time, and surgery duration), and postoperative complications (chorioamniotic membrane separation [CAS] and septostomy).

Results:
Of 562 pregnancies with TTTS and undergoing FLP, 75 (13%) were delivered due to suspected placental abruption. Baseline demographic and operative characteristics were similar between groups. Abruption was associated with earlier gestational age at delivery (29.2 ± 3.4 vs 30.7 ± 4.4 weeks, p < 0.001). Anterior placentation was independently associated with abruption (OR 1.95, 95% CI 1.07–3.53; p = 0.03). No other intraoperative or postoperative variables were significantly associated with risk of abruption.

Conclusion:
Anterior placentation is an independent risk factor for placental abruption following FLP for TTTS. Its identification may inform risk stratification, preoperative counseling, and postoperative surveillance.