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International Journal of Reproductive BioMedicine
By Sareh Mokhtari, Laleh Eslamian, Vajiheh Marsoosi and 3 others.
Indomethacin is administered to reduce preterm labor after fetoscopic laser photocoagulation (FLP) of placental anastomoses.
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To compare ductus arteriosus (DA) Doppler findings in monochorionic diamniotic twin pregnancies complicated by twin-to-twin transfusion syndrome following FLP between cases treated with indomethacin and those treated with nifedipine. Materials and Methods: In this retrospective cohort study, data of 86 pregnant women aged 17–41 yr who underwent FLP in Shariati hospital, Tehran, Iran from October 2024-November 2025 were extracted from medical records and then followed up. In the study, based on pulse rate, the cases were placed in one of 2 groups: nifedipine (pulse rate < 100) and indomethacin (pulse rate > 100) for 48 hr. In cases receiving indomethacin, 6 cases developed DA constriction. A comprehensive fetal echocardiography was performed to assess the status of the DA before and after FLP.
Peak systolic velocity was higher in both donor (145.7 ± 32.2, p = 0.012) and recipient twins (147.2 ± 23.6, p = 0.010) in the constricted group compared with the non-constricted groups. In recipient twins, end-diastolic velocity mean was also significantly increased (32.0 in the constricted, 19.9 in the indomethacin, and 18.7 in the nifedipine group, p = 0.012), while pulsatility index mean was significantly lower in the constricted group (1.8, 2.6, 2.5, respectively, p = 0.010).
DA constriction is associated with significant changes in blood flow indices, a higher incidence of right ventricular dysfunction, and a greater prevalence of valvular regurgitation. In this study, fetal DA constriction resolved during the short-term follow-up period.
Published in International Journal of Reproductive BioMedicine (IJRM). The abstract is shown as published and remains the work of its authors; read the full article at the source.
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