Fetoscopic Treatment of Twin‐to‐Twin Transfusion Syndrome After Spontaneous Preoperative Preterm Premature Rupture of the Membranes

ABSTRACT

We successfully performed a fetoscopic laser ablation (FLA) followed by amniopatch immediately after spontaneous preterm premature rupture of the membranes (PPROM) occurred in a 23‐week monochorionic‐diamniotic twin pregnancy complicated by Stage II twin‐to‐twin transfusion syndrome (TTTS). Since the severe polyhydramnios‐anhydramnios sequence was still observed after spontaneous PPROM, we established an emergent multidisciplinary meeting and consulted the hospital Fetal Ethical Boards. After multidisciplinary consensus and ethical approval, the procedure was successfully performed on the same day without complications. On Postoperative Day 1, no more leakage of fluid was observed. The patient had an uncomplicated course during the entire pregnancy, with complete resolution of the TTTS and the PPROM. At 34 weeks' gestation, she delivered two healthy twins by cesarean section. The infants are now 4 years old with complete normal neurological development. In conclusion, we demonstrate that FLA with amniopatch is a feasible option in specific cases of TTTS with preoperative PPROM.