Objective To analyze the effect of different maintenance methods for general anesthesia on pregnancy outcomes after selective laser photocoagulation of communicating vessels (SLPCV) for twin‑to‑twin transfusion syndrome (TTTS). Methods A total of 143 patients who were diagnosed with TTTS and underwent general anesthesia for SLPCV in the First Affiliated Hospital of Air Force Military Medical University from October 2016 to October 2022 were selected. According to the different anesthetics used for intraoperative anesthesia maintenance, they were divided into two groups: a total intravenous anesthesia (TIVA) group (group TIVA) and a volatile induction and maintenance anesthesia (VIMA) group (group VIMA). The patients were screened based on inclusion and exclusion criteria, and 104 cases were finally included, with 59 cases in the TIVA group (receiving propofol plus remifentanil during the operation) and 45 cases in the VIMA group (receiving sevoflurane plus remifentanil during the operation). Their general information were recorded, namely height, weight, body mass index (BMI), gravidity and parity, American Society of Anesthesiologists (ASA) grade, gestational weeks at the time of operation and Quintero stage. Furthermore, laboratory information, such as pre‑ and post‑operative hemoglobin (Hb) and hematocrit (Hct), as well as operative and anesthetic information, such as heart rate, baseline and minimum values of intraoperative systolic blood pressure (SBP) and diastolic blood pressure (DBP), SpO2, the incidence of emergency surgery, the duration of operation, the duration of anesthesia, the duration of anesthesia to onset of the operation, intraoperative fluid intake, intraoperative urine volume, reduction of intraoperative amniotic fluid volume, the use and dosage of ephedrine and epinephrine, and the number of cases of pulmonary edema were recorded. Moreover, their pregnancy outcomes, such as the incidence of premature rupture of membranes and spontaneous abortion/induced labor/stillbirth, one child survival/mortality rate within 48 h after operation, twin survival rate, and gestational weeks at birth were recorded. Results There was no difference between the two groups in age, height, weight, BMI, ASA grade, gravidity and parity, Quintero stage and gestational weeks at the time of surgery (P>0.05). There was no difference in Hct, Hb, heart rate, baseline SBP and DBP, baseline SpO2, the duration of operation, the duration of anesthesia, the duration of anesthesia to onset of the operation, intraoperative fluid intake, intraoperative urine volume, the use and dosage of ephedrine and the use of epinephrine before and after the operation (P>0.05). However, compared with the TIVA group, the VIMA group showed decreases in the minimum SBP and DBP (P<0.05), reduction of intraoperative amniotic fluid volume (P<0.05), but increases in the dosage of epinephrine (P<0.05). There was no difference between the two groups in the incidence of premature rupture of membranes and spontaneous abortion/induced labor/stillbirth, one child survival/mortality rate within 48 h after operation, twin survival rate, and gestational weeks at birth (P>0.05). Conclusions Although the minimum SBP and DBP in group VIMA are remarkably lower than those in group TIVA, no difference is found in pregnancy outcomes between the two groups. Therefore, each of the anesthesia maintenance methods can be used for SLPCV for TTTS.