Perinatal morbidity and mortality rates in severe twin-twin transfusion syndrome: Results of the International Amnioreduction Registry

Mari, Giancarlo; Roberts, Alistair; Detti, Laura; Kovancı, Ertuğ; Stefos, Theodor; Bahado‐Singh, Ray O.; Deter, Russell L.; Fisk, Nicholas M.

doi:10.1067/mob.2001.117188

Cited by 215 publications

(127 citation statements)

References 19 publications

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“…The survival with AR is significantly better in the NIH trial (60%) than in the Eurofoetus trial (41%) and consistent with single institution series [6][7][8][9][10][11][12] , a prospective randomized trial 15,16 , and registries (60-65%) 34,35 . This may be due to the standardized aggressive protocol used for serial AR in the NIH trial.…”

Section: Commentssupporting

confidence: 70%

“…It has been controversial which of these treatment options would provide the best outcome in specific cases of TTTS. AR has been associated with an average survival of 50% 33 , with large international registries reporting 60 to 65% survival 34,35 . Saade et al suggested the reason AR works is because it inadvertently creates an intertwin septostomy 36 .…”

Section: Introductionmentioning

confidence: 99%

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A prospective, randomized, multicenter trial of amnioreduction vs selective fetoscopic laser photocoagulation for the treatment of severe twin-twin transfusion syndrome

Crombleholme

Shera

Lee

et al. 2007

American Journal of Obstetrics and Gynecology

160

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Objective-To examine the effect of selective fetoscopic laser photocoagulation (SFLP) versus serial amnioreduction (AR) on perinatal mortality in severe twin-twin transfusion syndrome (TTTS).Study Design-5-year multicenter prospective randomized controlled trial. The primary outcome variable was 30-day postnatal survival of donors and recipients.Results-There is no statistically significant difference in 30-day postnatal survival between SFLP or AR treatment for donors at 55% (11/20) vs 55% (11/20) (p=1, OR=1, 95%CI=0.242 to 4.14) or Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. 35% (7/20) (p=0.25, OR=5.31, 95%CI=1.19 to 27.6). This is offset by increased recipient neonatal mortality of 30% (6/20) in the AR arm. Echocardiographic abnormality in recipient twin Cardiovascular Profile Score is the most significant predictor of recipient mortality (p=0.055, OR=3.025/point) by logistic regression analysis. NIH Public AccessConclusions-The outcome of the trial does not conclusively determine whether AR or SFLP is a superior treatment modality. TTTS cardiomyopathy appears to be an important factor in recipient survival in TTTS.

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Section: Commentssupporting

confidence: 70%

Section: Introductionmentioning

confidence: 99%

A prospective, randomized, multicenter trial of amnioreduction vs selective fetoscopic laser photocoagulation for the treatment of severe twin-twin transfusion syndrome

Crombleholme

Shera

Lee

et al. 2007

American Journal of Obstetrics and Gynecology

160

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“…21 If such factors are produced by the placenta, they would no longer be present after delivery, which would explain the observed postnatal regression of the disease, much like the HCM in infants of diabetic mothers. Serial amniocenteses and endoscopic laser ablation of placental vascular anastomoses improve outcome of affected pregnancies 22,23 ; however, their affect on the cardiovascular manifestation has not been fully delineated.…”

Section: Extrinsic Causes Of Fetal CMmentioning

confidence: 99%

Fetal Cardiomyopathies

et al. 2002

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Background-Although the prenatal diagnosis of most fetal structural heart defects and dysrhythmias has been described, there is a paucity of information about cardiomyopathies (CMs) in prenatal life. Methods and Results--To determine the pathogenic mechanisms, hemodynamic findings, and outcome of fetal CM, we reviewed the fetal echocardiograms and perinatal histories of 55 affected fetuses. Dilated CM was diagnosed in 22 cases, including 2 with congenital infections, 5 familial cases, 6 with endocardial fibroelastosis related to maternal anti-Ro/La antibodies, and 9 idiopathic cases. Thirty-three had hypertrophic CM, 7 associated with maternal diabetes, 2 with Noonan's syndrome, 2 with ␣-thalassemia, 18 with twin-twin transfusion syndrome, 1 with familial hypertrophy, and 3 with idiopathic hypertrophy. Systolic dysfunction was present in all cases of dilated CM and 15 cases of hypertrophic CM. Diastolic dysfunction was present in 19 of 30 fetuses with assessment of diastolic function parameters. Significant mitral or tricuspid valve regurgitation was seen in 32 cases. Eight fetuses were hydropic and 23 had signs of early hydrops. Seven pregnancies were terminated. Of 46 continued pregnancies with follow-up, 29 (63%) died perinatally. The presence of systolic dysfunction, diastolic dysfunction, and significant atrioventricular valve regurgitation were identified as risk factors for mortality. By multiple logistic regression, diastolic dysfunction was associated with an 8-fold increased risk relative to the other parameters. Conclusions-Fetal CM has a broad spectrum of intrinsic and extrinsic causes. A poor outcome is observed in many affected fetuses. Diastolic dysfunction in fetal CM is associated with the highest risk of mortality. (Circulation. 2002; 106:585-591.)

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“…Amniyoredüksiyon yapılan grupta 28 hafta ve 32 hafta altında doğum oranı kontrol grubuna göre anlamlı olarak yüksek saptanmıştır. Amniyoredüksiyonun İİTS'unda % 41 oranında düzel-me sağladığını gösteren bulgular [11] mevcut olsa da İİTS olan hastalarda seri amniyoredüksiyonun araştırıldığı bir çalışmada tüm hastaların preterm doğum yaptığı gösterilmiştir [17]. Hastaların % 82.1 ine amniyoredüksiyon yapılan bir çalışmada da ortalama doğum haftası 29 hafta olarak bulunmuştur [18].…”

Section: Discussionunclassified

Effect of Amnioreduction on Maternal and Perinatal Outcomes in Patients with Twin - Twin Transfusion Syndrome

2016

Ann Clin Anal Med

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ÖzetAmaç: İkiz -ikiz transfüzyon sendromu (İİTS) tanısı konulan olgularda amniyoredüksiyon yapılmasının perinatal sonuçlarla ilişkisini belirlemek. Gereç ve Yöntem: İİTS tanısı alan 42 hasta çalışmaya dahil edildi. Bu hastalardan amnioredüksiyon yapılan 14 hasta çalışma grubunu, amnioredüksiyon yapılma-yan 28 hasta kontrol grubunu oluşturdu. Amniyoredüksiyonun ikizler üzerin-de doğum haftası, doğum ağırlığı, yenidoğan yoğun bakım ihtiyacı ve perinatal mortalite üzerine etkileri retrospektif olarak medikal kayıtlardan elde edildi. P değeri 0.05 değerinin altında anlamlı kabul edildi. Bulgular: Amniyoredüksiyon yapılan hastalarda doğum haftası 28.7 ± 4.1 iken kontrol grubunda 31.8 ± 4.9 olarak bulundu. Amniyoredüksiyon yapılan hastalarda, 32 hafta altı 12 (%85.7) ve 28 hafta altı 10 (%71.4) hastada doğum görülürken kontrol grubunda, 32 hafta altı 12 (%43.1) ve 28 hafta altı 9 (%32.1) hastada doğum gerçekleşti (P<0.05). Amniyoredüksiyon yapılan hastalarda alıcı ikizin doğum ağırlığı 1385 ± 711 gr iken kontrol grubunda 2104 ± 741 gr olarak bulundu (P<0.05). Amniyoredüksiyon yapılan hastalarda yenidoğanların 24'ü (%92.3) yenidoğan yoğun bakım ihtiyacı duyarken kontrol grubu yenidoğanla-rının 40'ının (% 71.4) yenidoğan yoğun bakım ihtiyacı olmuştur (p=0.11). Tartışma: Çalışmamızda amniyoredüksiyon İİTS olgularında perinatal sonuçlar üzerine olumlu bir etkisi bulunamamıştır. Anahtar Kelimelerİkiz -İkiz Transfüzyon Sendromu; Amniyoredüksiyon; Maternal Sonuç; Perinatal Sonuç Abstract Aim: To assess the effect of amnioreduction on perinatal outcomes in patients with twin -twin transfusion syndrome (TTTS). Material and Method: 42 patients with TTTS were enrolled into this study. 14 of 42 patients who underwent amnioreduction formed the study group and 28 of 42 patients who did not undergo amnioreduction formed the control group. Effects of amnioreduction on average week of birth, birth weight, need of neonatal intensive care and perinatal mortality were gathered from medical records retrospectively. P score under 0.05 was accepted as significant. Results: Average week of birth of women who underwent amnioreduction was 28.7 ± 4.1 however it was 31.8 ± 4.9 on control group. Although number of births under 32 weeks is 12 (85.7%) and under 28 weeks is 10 (71.4%) on patients who underwent amnioreduction, it was 12 (43.1%) for under 32 weeks and 9 (32.1%) for under 28 weeks in control group (P<0.05). Birth weight of recipient twin was 1385 ± 711 gr in amnioreduction group and 2104 ± 741 gr in control group (P<0.05). 40 newborns (71.4%) of the control group needed neonatal intensive care however 24 newborns (92.3%) of the amnioreduction group needed neonatal intensive care (p=0.11). Discussion: In this study, we did not find any positive effect of amnioreduction on perinatal outcomes in pregnant women with TTTS.

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Perinatal morbidity and mortality rates in severe twin-twin transfusion syndrome: Results of the International Amnioreduction Registry

Cited by 215 publications

References 19 publications

A prospective, randomized, multicenter trial of amnioreduction vs selective fetoscopic laser photocoagulation for the treatment of severe twin-twin transfusion syndrome

A prospective, randomized, multicenter trial of amnioreduction vs selective fetoscopic laser photocoagulation for the treatment of severe twin-twin transfusion syndrome

Fetal Cardiomyopathies

Effect of Amnioreduction on Maternal and Perinatal Outcomes in Patients with Twin - Twin Transfusion Syndrome

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