Long-Term Neurodevelopmental Outcome of Monochorionic Twins after Laser Therapy or Umbilical Cord Occlusion for Twin-Twin Transfusion Syndrome

Abstract

Introduction: We sought to assess the incidence of severe neurodevelopmental impairment (NDI) in monochorionic twins treated for twin-twin transfusion syndrome (TTTS) and compare it to the incidence in uncomplicated monochorionic twins. Material and Methods: We included TTTS pregnancies treated by fetoscopic selective laser coagulation (FSLC) or umbilical cord occlusion (UCO) in 2004–2015. Primary outcome was severe NDI defined as cerebral palsy, bilateral blindness or bilateral deafness (ICD-10 diagnoses), and severe cognitive and/or motor delay (assessed by the Ages and Stages Questionnaires [ASQ]). Results: A total of 124 children after TTTS and 98 controls were followed up at 25 months of age (SD 11.4). Severe NDI was found in 8.9% of the TTTS children (10.5% [9/86] after FSLC; 5.3% [2/38] after UCO) compared to 3.1% in the control group (p = 0.10). The odds ratio for severe NDI was 1.8 in cases versus controls (p = 0.37). The total ASQ score was significantly lower in the TTTS group than in controls (p = 0.03) after FSLC (p = 0.03) and after UCO (p = 0.14). Discussion: Children after TTTS appear to have a higher risk of severe NDI and score significantly lower on the ASQ compared to monochorionic twins from uncomplicated pregnancies.

Selective fetal termination in monochorionic twin pregnancies - pregnancy outcome after bipolar cord coagulation and interstitial laser coagulation

“…Few studies report neonatal morbidity and mortality after SFT, and even fewer evaluate neurological or psychomotor development, reporting normal development in the age of two years in 70-92%, explaining impaired development by prematurity [15][16][17][18][19][20]. In our series, no specific neonatal morbidity was reported after both BCC and ILC, except for those that are a consequence of prematurity.…”

Impact of Preoperative Cervical Length on Pregnancy Outcome in Twin-Twin Transfusion Syndrome

“…Indeed, our data showed that 70 % of patients with a preoperative cervical length ≤ 15 mm had at least one surviving twin. However, since neurological outcome is strongly associated with GA at birth, high preterm delivery rate < 32 weeks in this subset of patients should also be discussed [29,30].…”

Twin-to-twin Transfusion Syndrome: An Overview

“…31 Schou et al investigated the prevalence of severe neurodevelopment impairment (cerebral palsy, bilateral blindness and/or deafness, and severe cognitive and/or motor delay) in children at the age of 2 years after fetoscopic laser surgery for TTTS. 32 Nine out of 86 children (10.5%) were affected. It is important to know that follow-up studies reported varying rates of cerebral palsy and neurodevelopment impairment in TTTS treated cases with laser surgery.…”