Ultrasound assessment prior to laser photocoagulation for twin-twin transfusion syndrome for predicting intrauterine fetal demise after surgery in Japanese patients

Yamaguchi University, Yamaguti, Yamaguchi, Japan
Fetal Diagnosis and Therapy (Impact Factor: 2.3). 02/2007; 22(2):149-54. DOI: 10.1159/000097116
Source: PubMed

ABSTRACT To evaluate the use of ultrasound before selective laser photocoagulation of communicating vessels (SLPCV) for twin-twin transfusion syndrome in predicting intrauterine fetal demise (IUFD).
Fifty-five patients underwent SLPCV in Japan. Fetal biometry and Doppler studies of the umbilical artery, ductus venosus, and umbilical vein were performed prior to SLPCV. The visualization of the bladder and hydrops was recorded. Association between the parameters and IUFD was analyzed using multiple logistic regression analysis. The study was approved by the Institutional Review Board and patients gave their informed consent.
The IUFD incidence was 25.5% (14/55) in the donors and 12.7% (7/55) in the recipients. Twelve donors and 4 recipients of them ended in unexplainable IUFD. In the analysis of 53 donors, absent or reversed end-diastolic flow of umbilical artery (UAAREDF) was only associated with IUFD (p = 0.016). No parameters could predict IUFD in 52 recipients.
UAAREDF may be useful for predicting IUFD of the donor after SLPCV.

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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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    ABSTRACT: To evaluate the independent and combined value of gestational age, fetal weight, feto-placental Doppler, and myocardial performance index for the prediction of individual risk of early (≤7 days) intrauterine fetal death (IUFD) after laser therapy in twin-twin transfusion syndrome (TTTS). A consecutive series of 215 cases of TTTS treated with laser therapy in 3 centers was prospectively studied. Ultrasound evaluation within 24 hours of surgery included estimated fetal weight discordance (EFWD), umbilical artery (UA) pulsatility index (PI) and diastolic flow evaluation, middle cerebral artery PI (MCAPI) and peak systolic velocity (MCAPSV), ductus venosus PI and atrial flow assessment and modified myocardial performance index. Logistic regression analysis was used to explore the association of preoperative parameters with IUFD. IUFD occurred in 17 (7.9%) of recipients and 33 (15.3%) donors (p = 0.016). The only independent predictors of IUFD in recipients was MCAPSV > 1.5MoM (OR = 22, p = 0.015), but this event was present in only 3% of recipients. In donors, reverse end diastolic flow in the UA (OR = 14.748, p = 0.033), EFWD (OR = 1.054, p = 0.036) and gestational age (OR = 0.757, p = 0.046) were independent predictors. In TTTS, preoperative fetal assessment can identify independent risk factors for early postoperative IUFD, particularly in donors. This article is protected by copyright. All rights reserved.
    Prenatal Diagnosis 11/2013; 33(11). DOI:10.1002/pd.4191 · 2.51 Impact Factor
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