Comparison of indomethacin and nifedipine regarding ductus arteriosus Doppler findings after laser therapy for monochorionic diamniotic twin-to-twin transfusion syndrome: A retrospective cohort study

Background: Indomethacin is administered to reduce preterm labor after fetoscopic laser photocoagulation (FLP) of placental anastomoses. Objective: 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 ۸۶ pregnant women aged ۱۷-۴۱ yr who underwent FLP in Shariati hospital, Tehran, Iran from October ۲۰۲۴-November ۲۰۲۵ were extracted from medical records and then followed up. In the study, based on pulse rate, the cases were placed in one of ۲ groups: nifedipine (pulse rate < ۱۰۰) and indomethacin (pulse rate > ۱۰۰) for ۴۸ hr. In cases receiving indomethacin, ۶ cases developed DA constriction. A comprehensive fetal echocardiography was performed to assess the status of the DA before and after FLP. Results: Peak systolic velocity was higher in both donor (۱۴۵.۷ ± ۳۲.۲, p = ۰.۰۱۲) and recipient twins (۱۴۷.۲ ± ۲۳.۶, p = ۰.۰۱۰) in the constricted group compared with the non-constricted groups. In recipient twins, end-diastolic velocity mean was also significantly increased (۳۲.۰ in the constricted, ۱۹.۹ in the indomethacin, and ۱۸.۷ in the nifedipine group, p = ۰.۰۱۲), while pulsatility index mean was significantly lower in the constricted group (۱.۸, ۲.۶, ۲.۵, respectively, p = ۰.۰۱۰). Conclusion: 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.

کلیدواژه ها:

Doppler echocardiography ، Ductus arteriosus ، Fetofetal transfusion ، Laser therapy. ، اکوکاردیوگرافی داپلر ، مجرای شریانی ، انتقال خون جنین به جنین ، لیزر درمانی.