Changes in sVEGFR-1 and sVEGFR-2 Levels Following Fetoscopic Laser Photocoagulation in Twin-to-Twin Transfusion Syndrome: Implications for Fetal demise Prediction.

Background: Twin-to-twin transfusion syndrome (TTTS) is a severe complication in monochorionic twin pregnancies, leading to high perinatal morbidity and mortality. Fetoscopic laser photocoagulation (FLP) is the gold standard treatment; however, fetal demiseremains a concern. The soluble vascular endothelial growth factor receptors, sVEGFR-1 and sVEGFR-2, play a crucial role in regulating angiogenesis and vascular function. This study evaluates changes in sVEGFR-1 and sVEGFR-2 levels before and after FLP and explores their role in predicting fetal demise post-surgery. Objective: Therefore, this study aims to evaluate pre- and post-surgical changes in sVEGFR-1 and sVEGFR-2 levels in TTTS cases treated with FLP and determine their predictive value for fetal demiseafter surgery. Results: Statistics showed that VEGF-R1 levels were significantly decreased after surgery and change in soluble VEGF-R1 levels after surgery had a difference between the group of fetal demise and non-fetal demise. ROC curve showed that degree of VEGF-R1 levels reduction after surgery were higher, the risk of fetal demise was bigger (AUC: 0.8472), in which, cut-off point of degree of VEGF-R1 levels reduction after surgery was 36.5% (sensitivity: 66.67%, specificity: 95.83%). Conclusion: Our data suggest that change in VEGF-R1 after surgery could play a prognostic role of fetal demise after fetoscopic laser surgery.