Perinatal survival in cases of twin–twin transfusion syndrome complicated by selective intrauterine growth restriction. (29th September 2014)

• Record Type: Journal Article
• Authors: Van Winden, Kristi R.; Quintero, Rubén A.; Kontopoulos, Eftichia V.; Korst, Lisa M.; Llanes, Arlyn; Chmait, Ramen H.
• Is Part Of: Journal of maternal-fetal & neonatal medicine. Volume 28:Number 13(2015)
• Page Start: 1549
• Page End: 1553
• Publication Date: 2014-09-29
• Subjects: Fetal growth restriction -- fetoscopy -- laser surgery -- monochorionic -- SIUGR -- TTTS; Obstetrics -- Periodicals; Perinatology -- Periodicals; Infants (Newborn) -- Diseases -- Periodicals; Neonatology -- Periodicals; 618.2
• Languages: English
• ISSNs: 1476-7058

Abstract

Abstract: Objective : To evaluate the impact of selective intrauterine growth restriction (SIUGR) on monochorionic multiples treated with selective laser photocoagulation of communicating vessels (SLPCVs) for twin-twin transfusion syndrome (TTTS). Methods : Perinatal survival was compared among TTTS patients with and without SIUGR. The TTTS + SIUGR group was defined as TTTS patients with donor twin weight <10th percentile. Multivariable logistic regression analyses identified factors associated with 30-day survival. Results : Of 369 patients, 65% ( N = 241) had TTTS + SIUGR. Thirty-day donor twin survival for the TTTS-only group was 84% versus 75% in the TTTS + SIUGR group ( p = 0.0348). Stage III donor involved (stage III donor, donor/recipient) TTTS + SIUGR patients ( N = 110) had 66% 30-day donor survival. Multivariable logistic regression demonstrated that the TTTS-only group was twice as likely to achieve donor survival compared to the TTTS + SIUGR group (OR 2.01, 95% CI 1.11–3.66, p = 0.0214). In the TTTS + SIUGR group, patients not classified as stage III donor-involved were twice as likely to achieve donor survival as stage III donor-involved patients (OR 2.02, 95% CI 1.10–3.71, p = 0.0226). Conclusions : SIUGR, present in two-thirds of TTTS patients, was a risk factor for decreased donor survival. Patients with donor SIUGR and umbilical artery persistent or reversed end-diastolic flow (Quintero Stage III Donor-involved) were especially at risk.