Seguridad de la anestesia neuroaxial en mujeres con embarazo gemelar y síndrome de transfusión fetofetal, sometidas a fotocoagulación láser. Estudio de cohorte retrospectiva

Abstract

Objective: Describe clinical characteristics and frequency of maternal, fetal, and neonatal complications based on anesthetic technique in patients undergoing fetal surgery for Twin-to-Twin Transfusion Syndrome (TTTS) treated with laser photocoagulation (LP). Material and methods: Retrospective cohort study. We included pregnant women with TTTS treated with LP and neuraxial anesthesia (NA) at Fundación Valle del Lili, Cali (Colombia), between 2013-2017. Patients with Quintero stage-V were excluded. Descriptive statistics were used. Institutional Review Board approved the study protocol. Results: 32 participants met the inclusion and exclusion criteria. The population was characterized by being made up of young, multiparous women. The emergent intervention was performed in 87.5 % of the cases, 43.7 % with Quintero stage-III, and epidural anesthesia was used in 56.2 % of the pregnant women. The maternal hemodynamic variables exhibited a similar behavior according to the moment and the neuraxial anesthesia technique implemented. 65.6% of the pregnant women presented sustained hypotension and 9.3 % developed pulmonary edema. 65.6 % of pregnancies experienced preterm delivery and 18.7 % premature rupture of membranes. Fourteen fetal deaths and five neonatal deaths were recorded among the 64 fetuses that made up the cohort. There were no cases of maternal mortality. Conclusion: In patients with STFF who require FL, the use of epidural, spinal or combined anesthesia is probably associated with a similar behavior for maternal hemodynamic variables. The professionals who provide care for these pregnant women must be alert to the frequent appearance of maternal, fetal and neonatal complications. Studies are required to evaluate the safety and effectiveness of the different neuraxial anesthesia techniques in patients with STFF.