Development of acute feto-fetal transfusion in delivery of monochorionic diamniotic twins
Authors:   Maternity Hospital No 17, Saint Petersburg, Russian Federation, Mikhailov A.V. ,   Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russian Federation,   I.I.Mechnikov North-Western State Medical University, Saint Petersburg, Russian Federation,   D.O.Ott Research Institute of Obstetrics, Gynecology and Reproductive Medicine, Saint Petersburg, Russian Federation, Romanovsky A.N. ,   Maternity Hospital No 17, Saint Petersburg, Russian Federation,   Saint Petersburg State University, Saint Petersburg, Russian Federation, Volchenkova V.E. ,   Maternity Hospital No 17, Saint Petersburg, Russian Federation,   I.I.Mechnikov North-Western State Medical University, Saint Petersburg, Russian Federation, Kuznetsov A.A. ,   Maternity Hospital No 17, Saint Petersburg, Russian Federation,   Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russian Federation, Kyanksep A.N. ,   Maternity Hospital No 17, Saint Petersburg, Russian Federation,   Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russian Federation, Savelyeva A.A. ,   Maternity Hospital No 17, Saint Petersburg, Russian Federation, Osipova A.V. ,   Maternity Hospital No 17, Saint Petersburg, Russian Federation, Tsyganova M.K. ,   D.O.Ott Research Institute of Obstetrics, Gynecology and Reproductive Medicine, Saint Petersburg, Russian Federation
Published: April 2024

Objective. To determine the incidence and characteristics of acute feto-fetal transfusion (FFT) in patients with an uncomplicated monochorionic diamniotic (MCDA) twin pregnancy who had a vaginal delivery and to compare their perinatal outcomes with those patients who underwent elective cesarean section. Patients and methods. This retrospective study included data on perinatal outcomes of 92 births in patients with MCDA twins delivered at the Maternity Hospital No 17 between 2019 and 2021. All patients were divided into two groups according to the mode of delivery: the study group (n = 49) – vaginal delivery, the control group (n = 43) – elective cesarean section before the onset of labor. Results. No diagnostically significant signs of acute FFT were found among newborns delivered by cesarean section. Acute FFT was detected in four neonates born to two (4%) patients delivered vaginally. These neonates had the Apgar score at 1 minute and 5 minutes greater than 7. Only one of these four neonates required phototherapy for neonatal jaundice caused by polycythemia and transfer to a pediatric hospital for stage 2 neonatal nursing. When comparing perinatal outcomes in patients in both groups delivered after 36 weeks’ gestation, no statistically significant differences in Apgar scores at 1 minute and 5 minutes and differences in hemoglobin levels in newborns were found regardless of delivery. In case of delivery before 36 weeks’ gestation, Apgar scores at 1 minute and 5 minutes were statistically significantly higher in the vaginal delivery group than in the cesarean section group. Conclusion. The data obtained show a low incidence of acute FFT in neonates born through vaginal delivery in an uncomplicated MCDA twin pregnancy and the absence of this complication in newborns delivered by cesarean section. When this specific complication of MCDA twin pregnancy developed among newborns, no perinatal losses were detected, and subsequent postnatal outcomes were favorable. It appears that further studies to clarify the diagnostic criteria and risk factors for the development of acute FFT in labor and the long-term health outcomes for newborns in an uncomplicated MCDA twin pregnancy may reduce the rate of cesarean delivery without worsening perinatal outcomes. Key words: monochorionic twins, acute feto-fetal transfusion, twin-to-twin transfusion syndrome, twin anemia polycythemia sequence