Preoperative predictors of death in twin-to-twin transfusion syndrome treated with laser ablation of placental anastomoses

Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Weill Cornell College of Medicine, New York, NY, USA.
American journal of obstetrics and gynecology (Impact Factor: 3.97). 10/2010; 203(4):388.e1-388.e11. DOI: 10.1016/j.ajog.2010.06.018
Source: PubMed

ABSTRACT To determine preoperative predictive factors for donor and recipient death after laser ablation of placental vessels in twin-to-twin transfusion syndrome.
Retrospective analysis of North American Fetal Therapy Network center laser procedures, 2002-2009. Factors associated with donor and recipient death were identified by regression analysis.
There were 466 patients from 8 centers. Factors significantly associated with donor fetal death were low donor estimated fetal weight (odds ratio [OR], 0.69; 95% confidence interval [CI], 0.55-0.87) and reversed end diastolic velocity in the umbilical artery (OR, 4.0; 95% CI, 1.54-10.2); for recipient fetal death-low recipient estimated fetal weight (OR, 0.65; 95% CI, 0.44-0.95), recipient reversed "a" wave in the ductus venosus (OR, 2.39; 95% CI, 1.27-4.51) and hydrops (OR, 3.7; 95% CI, 1.1-12.7); for recipient neonatal death-low donor estimated fetal weight (OR, 0.54; 95% CI, 0.30-0.95), high recipient estimated fetal weight (OR, 1.55; 95% CI, 1.06-2.26) and recipient reversed end diastolic velocity in the umbilical artery (OR, 7.8; 95% CI, 1.03-59.3).
Preoperative findings predict fetal and neonatal demise in twin-to-twin transfusion syndrome treated with laser therapy.

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    ABSTRACT: Objective: Selective fetoscopic laser photocoagulation (SFLP) is now the treatment of choice for twin-twin transfusion syndrome (TTTS). The incidence of recurrent TTTS following SFLP has been inconsistently reported across different studies. We performed a systematic review of TTTS recurrence following SFLP. Methods: Pubmed and Medline online databases were searched for articles published between 2000 and August 2011, using combinations of the terms "twin-twin transfusion", "TTTS", "laser", "recur" and "outcome". Citations identified in the primary search were screened for eligibility. Studies reporting outcomes from selective SFLP for TTTS in twin pregnancies, which addressed specifically the issue of TTTS recurrence, were included. The primary outcome was rate of TTTS recurrence. Secondary outcomes were therapeutic preference and fetal outcomes in cases of recurrent TTTS. Results: The primary search identified 22 eligible studies which were included in this review (n=2,447 twin pregnancies). Two studies included a minority of non-selective procedures. The published incidence of recurrent TTTS ranged from 0-16%. Clinical management was reported in 66% (71/108) cases, with repeat SFLP the most commonly performed secondary intervention. Only 3 studies provided comprehensive outcome data for cases of recurrent TTTS. The overall rate of neurologically-intact survival was 38% (20/52). Data were insufficient to determine the effects of secondary therapeutic approach, placental location or gestational age on perinatal outcome in cases of recurrent TTTS. Conclusions: The published rate of TTTS recurrence following SFLP in monochorionic twin pregnancy ranges from 0-16%. Although limited follow-up data suggest recurrence is associated with significant perinatal mortality and morbidity, further study is needed. Currently, there are insufficient data available to guide recommendations for clinical management of TTTS recurrence. Future studies on SFLP for TTTS must include details on recurrence rates and provide outcome data specific to the recurrent subset. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.
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