Long-term follow-up of complicated monochorionic twin pregnancies: Focus on neurodevelopment

Knijnenburg, Patricia J.C.; Lopriore, Enrico; Slaghekke, Femke; Klink, Jeanine M.M. van

doi:10.1016/j.bpobgyn.2022.03.014

Cited by 6 publications

(4 citation statements)

References 67 publications

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Section: Interpretation Of Findings and Comparison With Other Publish...supporting

confidence: 79%

“…In our case, the severe 2 year NDI rate was 2.38%, close to the lower range in studies in this synthesis. The overall rate of NDI in our series was 9.52%, and this data are in the range of those international studies published on this subject [14,23,[26][27][28][29]. To ascertain whether these data represent a true increase related to the disease, we performed a comparison with a cohort of children born from uncomplicated MCDA gestations, adjusting the results for weight and gestational age, as these are considered to be the main factors related to neurodevelopment [24,25,56].…”

Section: Interpretation Of Findings and Comparison With Other Publish...mentioning

confidence: 50%

“…There is a recent systematic review analyzing 26 studies performed between 1999 and 2021, which descriptively reports the rate of NDI after laser fetoscopy [28]. The authors included 2443 patients in their review, reporting a rate of CP ranging from 2% to 18% (mean 5%) and an overall rate of NDI that ranged from 4% to 18% (mean 9%).…”

Section: Interpretation Of Findings and Comparison With Other Publish...mentioning

confidence: 99%

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Two Year Neurodevelopmental Outcome after Fetoscopic Laser Therapy for Twin–Twin Transfusion Syndrome: Comparison with Uncomplicated Monochorionic Diamniotic Twins

2023

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Background: Twin–twin Transfusion Syndrome (TTTS) represents a significant complication in monochorionic twin pregnancies, caused by an unbalanced shunting of blood through intertwin placental vascular anastomoses. Despite advances in fetoscopic laser surgery, TTTS is still associated with a high rate of cerebral injury. However, there are no studies comparing these pregnancies with uncomplicated monochorionic diamniotic (MCDA) twin pregnancies, establishing the baseline risk of neurodevelopmental impairment. The aim of this study is to evaluate the odds of neurodevelopmental impairment in MCDA twins who undergo fetoscopic laser surgery for twin–twin transfusion syndrome, in comparison to a cohort of uncomplicated MCDA twin pregnancies. Study design: This is a retrospective cohort study of children born from MCDA twin pregnancies at a single center between 2008 and 2019. A routine, standardized follow-up assessment was conducted at a minimum of 2 years after delivery. The primary outcome of this was a 2 year neurodevelopmental impairment. Neurological, motor, and cognitive development was assessed by using the revised Brunet–Lézine scale. Results: 176 children met the enrolment criteria. Of these, 42 (24%; TTTS group) underwent fetoscopic laser surgery for TTTS during pregnancy, and 134 (76%; uncomplicated MCDA group) were uncomplicated MCDA pregnancies. The primary outcome was found in four children (9.52%) in the TTTS group and ten children (7.46%) in the uncomplicated MCDA group (p = 0.67, aOR 2.82, 95% CI 0.49–16.23). Major neurologic impairment was found in 2.38% after fetoscopic laser surgery and 1.49% in uncomplicated MCDA twins (p = 0.70, aOR 0.97, 95% CI 0.22–4.24). The data were adjusted by birth order, birth weight, and gestational age at birth. Conclusions: The outcome in MCDA twins who underwent fetoscopic laser surgery for TTTS is comparable to the outcome in uncomplicated MCDA twins. Our findings emphasize the need for long-term neurodevelopmental follow-ups in all children from monochorionic twin gestations.

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Section: Interpretation Of Findings and Comparison With Other Publish...supporting

confidence: 79%

Section: Interpretation Of Findings and Comparison With Other Publish...mentioning

confidence: 50%

Section: Interpretation Of Findings and Comparison With Other Publish...mentioning

confidence: 99%

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Two Year Neurodevelopmental Outcome after Fetoscopic Laser Therapy for Twin–Twin Transfusion Syndrome: Comparison with Uncomplicated Monochorionic Diamniotic Twins

2023

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“…In addition, a large cohort of TTTS survivors with and without a ruptured intertwin membrane was evaluated at the age of 2 years. Follow-up of this high-risk group is of utmost importance to improve treatment strategies, to refine counselling, and to offer timely support in children with neurodevelopmental difficulties [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

Intertwin Membrane Perforation and Umbilical Cord Entanglement after Laser Surgery for Twin-Twin Transfusion Syndrome: Prevalence, Risk Factors, and Outcome

Knijnenburg¹,

Slaghekke²,

Rahmattulla³

et al. 2023

Fetal Diagn Ther

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Introduction: Perforation of the intertwin membrane can occur as a complication of fetoscopic laser surgery for twin-twin transfusion syndrome (TTTS). Data on the occurrence and the risk of subsequent cord entanglement are limited. The objective of this study was to assess the prevalence, risk factors and outcome of intertwin membrane perforation, and cord entanglement after laser surgery for TTTS. Methods: In this multicenter retrospective study, we included all TTTS pregnancies treated with laser surgery in two fetal therapy centers, Shanghai (China) and Leiden (the Netherlands) between 2002 and 2020. We evaluated the occurrence of intertwin membrane perforation and cord entanglement after laser, based on routine fortnightly ultrasound examination and investigated the risk factors and the association with adverse short- and long-term outcomes. Results: Perforation of the intertwin membrane occurred in 118 (16%) of the 761 TTTS pregnancies treated with laser surgery and was followed by cord entanglement in 21% (25/118). Perforation of the intertwin membrane was associated with higher laser power settings, 45.8 Watt versus 42.2 Watt (p = 0.029) and a second fetal surgery procedure 17% versus 6% (p < 0.001). The group with intertwin membrane perforation had a higher rate of caesarean section (77% vs. 31%, p < 0.001) and a lower gestational age at birth (30.7 vs. 33.3 weeks of gestation, p < 0.001) compared to the group with an intact intertwin membrane. Severe cerebral injury occurred more often in the group with intertwin membrane perforation, 9% (17/185) versus 5% (42/930), respectively (p = 0.019). Neurodevelopmental outcome at 2 years of age was similar between the groups with and without perforation of the intertwin membrane and between the subgroups with and without cord entanglement. Conclusion: Perforation of the intertwin membrane after laser occurred in 16% of TTTS cases treated with laser and led to cord entanglement in at least 1 in 5 cases. Intertwin membrane perforation was associated with a lower gestational age at birth and a higher rate of severe cerebral injury in surviving neonates.

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The Arabin cervical pessary for the prevention of preterm birth in twin-to-twin transfusion syndrome treated by fetoscopic laser coagulation: a multicenter randomized controlled trial

Rodo,

Maiz,

Arevalo

et al. 2024

American Journal of Obstetrics and Gynecology

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Long-term follow-up of complicated monochorionic twin pregnancies: Focus on neurodevelopment

Cited by 6 publications

References 67 publications

Two Year Neurodevelopmental Outcome after Fetoscopic Laser Therapy for Twin–Twin Transfusion Syndrome: Comparison with Uncomplicated Monochorionic Diamniotic Twins

Two Year Neurodevelopmental Outcome after Fetoscopic Laser Therapy for Twin–Twin Transfusion Syndrome: Comparison with Uncomplicated Monochorionic Diamniotic Twins

Intertwin Membrane Perforation and Umbilical Cord Entanglement after Laser Surgery for Twin-Twin Transfusion Syndrome: Prevalence, Risk Factors, and Outcome

The Arabin cervical pessary for the prevention of preterm birth in twin-to-twin transfusion syndrome treated by fetoscopic laser coagulation: a multicenter randomized controlled trial

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