OC17.04: Twin–twin transfusion syndrome and COVID-19: impact on diagnosis, referral and eligibility for fetoscopic laser therapy and outcomes

To assess the clinical impact of the coronavirus disease 2019 (COVID- 19) pandemic on pregnancies complicated with Twin–twin transfusion syndrome (TTTS). Retrospective cohort of pregnancies with TTTS evaluated in our fetal surgery centre at Queretaro, Mexico for possible surgical fetoscopy. Maternal-fetal characteristics and perinatal outcomes of cases evaluated during the first year of the COVID-19 pandemic declaration (03/11/2020 - 03/10/2021) were retrospectively compared with those cases assessed during the same period in the previous year. 109 TTTS cases were evaluated, 54 during the COVID-19 pandemic and 55 in the previous year. In the former group, a higher proportion of cases with fetal surveillance interval longer than 2 weeks (70.4 vs. 47.3%, p = 0.01), TTTS complications precluding laser therapy such as IUFD, PPROM, or cervical dilatation with prolapsed amniotic membranes (18.5 vs. 1.8%, p < 0.01), advanced TTTS (53.7 vs 36.4%, p = 0.07), preoperative short cervix (25.9 vs 10.9%, p < 0.05), and lower overall perinatal survival (56.9 vs. 80.0%, p = 0.01 of at least one twin; and 39.2 vs 56.4%, p = 0.08 of both twins) were observed. A significantly lower number of cases were selected for fetoscopic laser therapy during the pandemic period (75.9 vs 92.7%, p = 0.01); similar postoperative outcomes were observed both study groups. In pregnancies with TTTS, the COVID-19 pandemic has shown an adverse impact involving suboptimal fetal surveillance, advanced stage at diagnosis, poorer survival rates, and higher number of complications that preclude fetosopic laser therapy. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.