Prognosis and long-term neurodevelopmental outcome in conservatively treated twin-to-twin transfusion syndrome

Abstract

BackgroundAmnioreduction remains a treatment option for pregnancies with twin-to-twin transfusion syndrome (TTTS) not meeting criteria for laser surgery or those in which it is not feasible. Amnioreduction is a relatively simple treatment which does not require sophisticated technical equipment. Previous reports of conservative management have indicated that major neurodevelopmental impairment occurs in 14.3-26% of survivors. The purpose of this study was to investigate long-term neurodevelopmental outcome in conservatively treated TTTS.MethodsDuring the nine-year study period from January 1996 to December 2004, all pregnancies with TTTS who were admitted to our center were investigated. TTTS was diagnosed by using standard prenatal ultrasound criteria, and staged according to the criteria of Quintero et al. We reviewed gestational age at diagnosis, gestational age at delivery, the stage of TTTS at diagnosis, and diagnosis to delivery interval. Neonatal cranial ultrasound findings were reviewed and the neurodevelopmental outcomes were evaluated.ResultsTwenty-one pregnancies with TTTS were included. Thirteen pregnancies (62%) were treated with serial amnioreduction. The mean gestational age at delivery was 28 weeks (22 - 34 weeks). The perinatal mortality rate was 42.9%. Twenty survivors were followed up until at least 3 years of age. The mean age at follow-up was 6.3 years (3 - 12 years). Six children (30%) had neurodevelopmental impairment. Four children (20%) had major neurodevelopmental impairment and two children (10%) had minor neurodevelopmental impairment. Children with neurodevelopmental impairment were delivered before 29 weeks of gestation.ConclusionsOur study showed a high rate of perinatal mortality and a high rate of major neurodevelopmental impairment in conservatively treated TTTS. The long-term outcomes for the survivors with TTTS were good when survivors were delivered after 29 weeks of gestation.

Fetal and postnatal brain MRI in premature infants with twin–twin transfusion syndrome

“…The incidence of brain injury seen on head ultrasound in these studies ranged widely from 6 to 64%, and definitions of brain injury varied. [16][17][18][19][20][21][22][23] We saw some evidence of brain injury on postnatal MRI in 15/22 (68%) infants in our study, and 12/22 (54%) had injury scores >1 using our scale. Only 4 of the 15 infants had any evidence of brain injury on head ultrasound, which confirms prior studies that MRI is more sensitive and specific than ultrasound, 12,13 especially for whitematter injury.…”

Prematurity and twinning

“…Recently, a study conducted in Japan on twenty survivors of 21 pregnancies with TTTS treated with elective amnioreduction and a mean gestational age at delivery of 28 weeks (range 22-34 weeks), showed a high rate (20%) of major developmental impairment and 10% of minor NDI at a mean age of 6 years (range 3-12 years). Interestingly, children with NDI were delivered before 29 weeks of gestation [27]. Discrepancies among results may be due to differences in diagnostic criteria, disease onset, severity of the TTTS, treatment modalities, and classification of cerebral lesions.…”

Invasive Procedures in Monochorionic Twins

“…The longterm outcomes for the survivors with TTTS were good when survivors were delivered after 29 weeks of gestation. 139 It appears though that severe TTTS cases have a high percentage of major neurodevelopmental impairment irrespectively of whether they are treated conservatively or with laser photocoagulation. The percentage of longterm neurologic complications in survivor neonates after lasertreatment for stage I TTTS has been reported about 3%.…”