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

Donepudi, Roopali; Espinoza, Jimmy; Nassr, Ahmed A.; Belfort, Michael A.; Shamshirsaz, Amir A.; Sanz‐Cortes, M.

doi:10.1002/uog.23519

Cited by 9 publications

(18 citation statements)

References 20 publications

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“…Fetoscopic laser surgery was performed in cases of Quintero stage II–IV and in cases of stage I if the patient had symptomatic polyhydramnios and/or a short cervix, defined as transvaginal cervical length less than 2.5 cm or concern for preterm labor. FLS was performed in the standard fashion under intravenous sedation as described previously by our group 7 . An ultrasound scan was performed 24–48 h after the surgery.…”

Section: Methodsmentioning

confidence: 99%

“…FLS was performed in the standard fashion under intravenous sedation as described previously by our group. 7 An ultrasound scan was performed 24-48 h after the surgery. Weekly ultrasound assessment was performed for 4-6 weeks to assess for recurrent TTTS or TAPS.…”

Section: Thismentioning

confidence: 99%

“…However, the rates of demise vary based on the definitions used, therefore counseling of families is not always accurate. While some studies have used estimated fetal weight (EFW) of either twin less than the 10th centile, some have used intertwin discordance of greater than 25% 7 . The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) has released guidelines to manage pregnancies complicated by sFGR and have defined it as EFW of either twin <10th centile and the intertwin discordance >25% 5 .…”

Section: Introductionmentioning

confidence: 99%

“…While some studies have used estimated fetal weight (EFW) of either twin less than the 10th centile, some have used intertwin discordance of greater than 25%. 7 The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) has released guidelines to manage pregnancies complicated by sFGR and have defined it as EFW of either twin <10th centile and the intertwin discordance >25%. 5 In order to help standardize the counseling, we propose determining risk of donor demise based on intertwin weight discordance (IWD) and to assess additional criteria like abnormalities in the Doppler studies that may increase predictive ability.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Methodsmentioning

confidence: 99%

Section: Thismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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“…18 The Delphi consensus definition has not yet been clinically validated, although a few studies have attempted to determine the clinical utility of adopting these new criteria. 10,17,19 This new expert consensus definition, has not yet been universally accepted nor clinically implemented in the United States at this time, and warrants further exploration.…”

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Selective Fetal Growth Restriction Type III

Chmait

Monson

Korst

et al. 2021

J of Ultrasound Medicine

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Objectives Per a recent expert definition, diagnosis of selective fetal growth restriction (sFGR) in monochorionic diamniotic twins is based on an estimated fetal weight (EFW) <3% as sole criterion and/or combinations of 4 contributory criteria (1 twin EFW <10%; 1 twin abdominal circumference <10%; EFW discordance ≥25%; and smaller twin umbilical artery [UA] pulsatility index >95th percentile). We assessed these criteria in sFGR Type III (intermittent absent or reversed end‐diastolic flow of the UA [iAREDF]) patients to test whether meeting the more stringent parameters of the consensus definition had worse outcomes, that is, progression to sFGR Type II (persistent AREDF) or twin‐twin transfusion syndrome; or secondarily, decreased dual survivorship. Methods This was a retrospective study of referred sFGR Type III patients (2006–2017). Patients were retrospectively categorized using consensus criteria for 2 comparisons: 1) EFW <3% versus remaining cohort; 2) EFW <3% or met all 4 contributory criteria versus remaining cohort. Results Forty‐eight patients were studied. Comparison 1: EFW <3% patients (58.3%) were not more likely to demonstrate disease progression (46.4% versus 65.0%, P = .2489) or worse dual survivorship (78.6% versus 85.0%, P = .7161). Comparison 2: EFW <3% or met all 4 contributory criteria (75.0%) patients were not more likely than the others to demonstrate progression (44.4% versus 83.3%, P = .0235) or worse dual survivorship (80.6% versus 83.3%, P = 1.0000). Conclusions In a referred cohort of sFGR Type III patients, there was no evidence that meeting more stringent parameters of the consensus definition was associated with disease progression or dual survivorship.

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Outcome following laser surgery of twin–twin transfusion syndrome complicated by selective fetal growth restriction: systematic review and meta‐analysis

D’Antonio

Marinceu

Prasad

et al. 2023

Ultrasound in Obstet & Gyne

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ObjectiveThe published literature mostly reports outcomes of twin pregnancies complicated by twin–twin transfusion syndrome (TTTS) without differentiating whether the pregnancy is also complicated by another pathology, such as selective fetal growth restriction (sFGR). The aim of this systematic review was to report the outcomes of monochorionic twin pregnancies undergoing laser surgery for TTTS complicated compared to those not complicated by the coexistence of sFGR.MethodsMedline, Embase and Cochrane databases were searched. The inclusion criteria were monochorionic diamniotic (MCDA) twin pregnancies with TTTS that are also complicated, compared to those non‐complicated by sFGR, undergoing laser therapy. The primary outcome was the overall fetal loss following laser surgery, defined as miscarriage and intra‐uterine death. The secondary outcomes included fetal loss within 24 h from laser surgery, survival at birth, preterm birth (PTB) prior to 32 weeks, PTB prior to 28 weeks of gestation, composite perinatal morbidity, neurological and respiratory morbidity, and survival free from neurological impairment. All these outcomes were explored in the overall population of twin pregnancies complicated compared to those not complicated by sFGR in the setting of TTTS, and in the donor and recipient twin separately. Random‐effect meta‐analyses were used to combine data and the results reported as pooled odd ratios (ORs) with their 95% confidence intervals (CIs).ResultsSix studies (1710 MCDA twin pregnancies) were included. The overall risk of fetal loss after laser surgery was significantly higher in MCDA twin pregnancies with TTTS complicated by sFGR (20.6% vs 14.56%) with an OR of 1.52, 95% CI 1.3‐1.9 (p<0.001). The risk of fetal loss was significantly higher for the donor but not for the recipient twin. The rate of alive twins was 79.4% (95% CI 73.3‐84.9%) in pregnancies complicated by TTTS with and 85.5% (95% CI 80.9‐89.6%) with no sFGR (pooled OR 0.66, 95% CI 0.5‐0.8; p<0.001). There was no significant difference in the risk of PTB prior to 32 (p=0.308) and prior to 28 weeks (p=0.310). Assessment of short‐ and long‐term perinatal morbidity was affected by the very small number of cases. There was no significant difference in the risk of composite (p=0.5189) or respiratory morbidity (p=0.531) between twins complicated by TTTS with compared to those without sFGR, while the risk of neurologic morbidity in the donor (OR 2.39, 95% CI 1.1‐5.2; p=0.029) but not in the recipient (p=0.361) twin was significantly higher in those with TTTS and sFGR. Survival free from neurological impairment was observed in 70.8% (95% CI 44.9‐91.0%) of twin pregnancies with TTTS complicate and in 75.8% (95% CI 51.9‐93.3%) of those not complicated by sFGR with no difference between the two groups.ConclusionssFGR coexisting with TTTS represents an additional risk factor for fetal loss following laser surgery. The findings of this meta‐analysis should be useful in individualized risk assessment of twin pregnancies complicated by TTTS and tailored counseling of the parents prior to laser surgery.This article is protected by copyright. All rights reserved.

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

Cited by 9 publications

References 20 publications

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

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

Selective Fetal Growth Restriction Type III

Outcome following laser surgery of twin–twin transfusion syndrome complicated by selective fetal growth restriction: systematic review and meta‐analysis

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