# Continuation of Pregnancy After Donor Twin Demise Following Fetoscopic Laser Photocoagulation to Treat Twin-Twin Transfusion Syndrome

## TL;DR

A pregnancy with twin-twin transfusion syndrome was treated with laser surgery, leading to the loss of one twin but the survival of the other with complications.

## Contribution

This case highlights the risks and outcomes of fetoscopic laser photocoagulation in managing TTTS with eccentric cord insertion.

## Key findings

- FLP resulted in the demise of the donor twin but allowed the recipient twin to survive with congenital pulmonary airway malformation.
- The surviving twin was delivered at 38 weeks with stable outcomes.
- The case underscores the need for close monitoring and timely intervention in high-risk pregnancies.

## Abstract

Monochorionic diamniotic (MCDA) pregnancy with eccentric cord insertion may lead to twin-twin transfusion syndrome (TTTS), which can be treated by fetoscopic laser photocoagulation (FLP). The procedure has its risks, including the demise of one or both twins. A 33-year-old primigravida woman with MCDA twins was diagnosed with TTTS and eccentric cord insertion at 18 weeks of gestation. FLP was performed, resulting in the demise of the donor twin. The surviving twin was later diagnosed with congenital pulmonary airway malformation and was delivered at 38 weeks with stable outcomes, while the papyraceous twin was delivered by manual extraction. This case discusses eccentric cord insertion as a possible cause of TTTS managed with FLP and its associated risks. It emphasizes the necessity for rigorous surveillance and timely interventions in high-risk pregnancies, showcasing the importance of a comprehensive care approach.