Perinatal outcomes of single fetal survivor after fetal intervention for complicated monochorionic twins

Hoffman, Mallory; Habli, Mounira; Donepudi, Roopali; Boring, Noemi; Johnson, Anthony; Moise, Kenneth J.; Papanna, Ramesha

doi:10.1002/pd.5278

Cited by 8 publications

(10 citation statements)

References 20 publications

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“…Given the increased risk for demise of the growth-restricted fetus following laser surgery for TTTS, identification of these at-risk fetuses may aid in counseling and could alter management decisions. Some argue that performing selective reduction of this fetus may improve overall pregnancy outcome with regard to GA at delivery, birth weight and long-term outcome of the surviving fetus [18][19][20] . If this option is available and considered, utilizing the definition with the best predictive value would be essential.…”

Section: Discussionmentioning

confidence: 99%

Prediction of post‐laser fetal death in selective growth restriction complicating twin–twin transfusion syndrome using standardized definitions

Donepudi

Espinoza

Nassr

et al. 2021

Ultrasound in Obstet & Gyne

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What are the novel findings of this work?Utilization of the Delphi contributory criteria for defining selective fetal growth restriction (sFGR) in pregnancies with twin-twin transfusion syndrome classifies more cases as having sFGR compared to other definitions. This definition also had the highest predictive value for donor twin demise following fetoscopic laser surgery for twin-twin transfusion syndrome. What are the clinical implications of this work?Standardization of the definition of sFGR should enable more consistent prediction of outcome. Not only does this influence our management decisions with regard to fetal surveillance, but it also enhances patient care and counseling, especially in cases requiring surgical management.

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Section: Discussionmentioning

confidence: 99%

Prediction of post‐laser fetal death in selective growth restriction complicating twin–twin transfusion syndrome using standardized definitions

Donepudi

Espinoza

Nassr

et al. 2021

Ultrasound in Obstet & Gyne

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show abstract

“…Given the increased risk for demise of the growth‐restricted fetus following laser surgery, patients could be offered a selective reduction of the smaller fetus if this option is available. This may improve overall pregnancy outcomes with regards to gestational age at delivery, 18 birth weight and long‐term outcomes of the surviving fetus. This can be performed either by radiofrequency ablation or by bipolar cord coagulation, the ideal approach is debatable 19,20 .…”

Section: Discussionmentioning

confidence: 99%

Twin twin transfusion syndrome with and without selective fetal growth restriction: Predictors of donor demise

et al. 2021

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Objective Evaluate survival in twin twin transfusion syndrome (TTTS) with and without selective fetal growth restriction (sFGR) after fetoscopic laser surgery (FLS). Methods Retrospective study of monochorionic diamniotic twins undergoing FLS. The cohort was classified as TTTS and TTTS with sFGR. Baseline, intra‐operative and postoperative variables were analyzed. Mann–Whitney U, Pearson chi‐square, Fisher's exact, t‐test and receiver operating characteristic (ROC) curve analysis were performed. Results Four hundred and ninety‐two pregnancies were included, 304 (61.78%) TTTS and 188 (38.22%) TTTS with sFGR. No difference in donor outcomes. TTTS group had higher donor estimated fetal weight (EFW%) percentile (19.7 ± 18.8 vs. 2.2 ± 2.1, p < 0.001). Significant predictors for demise at 30 days were 37% intertwin weight discordance (IWD) with donor EFW% < first (area under ROC curve [AUC] = 0.85, p = 0.001) or IWD >25% and intertwin umbilical artery pulsatility index discordance (DUAPI) ≥0.4 (AUC = 0.71, p = 0.001). Conclusion Combination of IWD of 37% and donor EFW%

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“…Fetoscopic laser surgery is the standard of care for the treatment of TTTS. This procedure aims to ablate the anastomoses between the fetal circulatory systems on the placental surface in order to enhance the survival of both fetuses, resolving the underlying pathophysiological process 3 . Dual and singleton TTTS survival rates among twin pairs who undergo and initially survive the surgery are now documented to be 70% and 90%, respectively 4,5 .…”

Section: Introductionmentioning

confidence: 99%

“…Risk factors associated with recipient fetal demise and dual demise have not been well described. In addition, rates of neonatal death have not been documented for donors or recipients, although other perinatal outcomes are available, such as neonatal survival after a single unspecified fetal demise, preterm labor, and preterm prelabor rupture of membranes (PPROM) 3,11,12 …”

Section: Introductionmentioning

confidence: 99%

“…This procedure aims to ablate the anastomoses between the fetal circulatory systems on the placental surface in order to enhance the survival of both fetuses, resolving the underlying pathophysiological process. 3 Dual and singleton TTTS survival rates among twin pairs who undergo and initially survive the surgery are now documented to be 70% and 90%, respectively. 4,5 Donor fetal demise is the most common death of a single twin in TTTS, 6 is well-defined, 7,8 and is largely nonmodifiable.…”

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confidence: 99%

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Predicting fetal and neonatal demise after fetoscopy for twin–twin transfusion syndrome using recursive partitioning

et al. 2021

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Objective Donor demise after laser surgery for twin–twin transfusion syndrome (TTTS) is well‐characterized, but recipient demise is not, nor is neonatal death. This study aims to characterize factors associated with recipient death, donor death, and dual twin death after laser, both before and after birth. Methods This is a prospective cohort study of monochorionic twin pairs who underwent laser ablation for TTTS. Risk factors for fetal and neonatal death of both twins were identified using univariable analysis and recursive partitioning, a novel statistical method to quantify contributions of each factor to outcomes. Results In 413 twin pairs, death of both twins occurred in 9.2% (38/413), donor death in 12.1% (50/413), and recipient death in 2.4% (10/413). Recursive partitioning showed that gestational age at delivery predicts dual twin death (below 23.7 weeks, likely [p < 0.001], above 28.3 weeks, unlikely [p = 0.004]). Abnormal umbilical artery Doppler and weight discordance predict donor demise (p < 0.001 and p = 0.033, respectively). Cervical length under 16 mm predicts neonatal death of both twins (p < 0.001). Conclusions Parents can gain individualized information about the survival of each fetus based on variables available from preoperative and delivery variables. Short cervix and premature delivery cause significant mortality in TTTS.

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Perinatal outcomes of single fetal survivor after fetal intervention for complicated monochorionic twins

Abstract: When single fetal demise occurs following fetoscopic laser photocoagulation, the surviving co-twin is more likely to survive to delivery but has higher PPROM rates and a shorter latency period compared with planned selective reduction for TTTS or other indications.

Cited by 8 publications

References 20 publications

Prediction of post‐laser fetal death in selective growth restriction complicating twin–twin transfusion syndrome using standardized definitions

Prediction of post‐laser fetal death in selective growth restriction complicating twin–twin transfusion syndrome using standardized definitions

Twin twin transfusion syndrome with and without selective fetal growth restriction: Predictors of donor demise

Predicting fetal and neonatal demise after fetoscopy for twin–twin transfusion syndrome using recursive partitioning

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