Perioperative Maternal-Fetal Outcomes in the Setting of Minimally Invasive Fetal Therapy for Complex Monochorionic Pregnancies with Monitored Anesthesia Care

Olivia Nelson; Nahla Khalek; Lezhou Wu; Meryl S William; Brittany Wohler; Elaina E Lin; Kha M Tran; Allan F Simpao

doi:10.1159/000530737

Perioperative Maternal-Fetal Outcomes in the Setting of Minimally Invasive Fetal Therapy for Complex Monochorionic Pregnancies with Monitored Anesthesia Care

Fetal Diagn Ther. 2023;50(5):387-396. doi: 10.1159/000530737. Epub 2023 Apr 24.

Authors

Olivia Nelson^{1

2

3}, Nahla Khalek^{2

4}, Lezhou Wu¹, Meryl S William¹, Brittany Wohler¹, Elaina E Lin^{1

2

3}, Kha M Tran^{1

2

3}, Allan F Simpao^{1

2

3}

Affiliations

¹ Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
² Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment (CFDT) at the Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
³ Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁴ Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.

PMID: 37094556
DOI: 10.1159/000530737

Abstract

Introduction: Fetoscopic selective laser photocoagulation (FSLPC) and selective cord occlusion with radiofrequency ablation (RFA) can improve fetal outcomes when vascular anastomoses between fetuses cause twin-to-twin transfusion syndrome (TTTS) or selective fetal growth restriction (sFGR) in multiple gestation pregnancies with monochorionic placentation. This study analyzed perioperative maternal-fetal complications and anesthetic management in a high-volume fetal therapy center over a 4-year period.

Methods: Included patients received MAC for minimally invasive fetal procedures for complex multiple gestation pregnancies between January 1, 2015, and September 20, 2019. Maternal and fetal complications, intraoperative maternal hemodynamics, medication usage, and reasons for conversion to general anesthesia, if applicable, were analyzed.

Results: A total of 203 (59%) patients underwent FSLPC and 141 (41%) had RFA. Four patients (2%; rate 95% CI: 0.00039, 0.03901) undergoing FSLPC had conversion to general anesthesia. No conversions to general anesthesia occurred in the RFA group. The incidence of maternal complications was higher in those who underwent FSLPC. No aspiration or postoperative pneumonia events were observed. Medication usage was similar in FSLPC and RFA groups.

Conclusion: A low rate of conversion to general anesthesia and no serious adverse maternal events were observed in patients receiving MAC.

Keywords: Fetal growth restriction; Fetal outcomes; Fetoscopy; Maternal complications; Multiple gestation pregnancy.