Risk of donor demise after laser therapy for twin–twin transfusion when complicated by growth discordance and abnormal umbilical artery Doppler findings*

Finneran, Matthew M.; Templin, Megan; Stephenson, Courtney D.

doi:10.1080/14767058.2017.1404983

Cited by 13 publications

(18 citation statements)

References 22 publications

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“…The reported rate of donor demise after SLPCV in all TTTS stages ranges from 11 to 28% [5,[8][9][10]. Previous studies have found Quintero stage III [5], UA-AEDV [7,9,12,14], UA-REDV [6-9, 12, 14], low EFW [10], fetal growth restriction [5], EFW discordance [6][7][8][9], early…”

Section: Discussionmentioning

confidence: 99%

“…Because of the documented association between percent EFW (%EFW) discordance and AEDV [7,9], we performed a similar but stratified set of analyses for those with and without fetal weight discordance, defined as preoperative %EFW discordance ≥20 versus < 20%. %EFW discordance was calculated as 100 × (EFW of larger twin -EFW of smaller twin)/EFW of larger twin.…”

Section: Methodsmentioning

confidence: 99%

“…In one such stratified analysis, Finneran et al [7] examined the risk of donor demise with AEDV or REDV by discordance (yes/no), defined as ≥20% difference in EFW between the donor and recipient, and found that, in patients with discordance, AEDV or REDV was a high risk factor of donor IUFD (RR 5.2, 95% CI 1.7-16.3), and in those without discordance there was a lower risk (RR 3.6, 95% CI 1.1-12.1) [7]. However, contrary to our study findings, they found that EFW discordance alone did not significantly increase the risk of IUFD (RR 3.2, 95% CI 0.8-13.2) [7]. Snowise et al [8] noted the presence of EFW discordance > 30% and REDV, together, was highly predictive of donor IUFD.…”

Section: 1125mentioning

confidence: 99%

“…Previous studies have shown that estimated fetal weight (EFW) discordance [6][7][8][9], hydrops fetalis [10], reverse blood flow in the ductus venosus [9][10][11], the presence of arterioarterial (AA) anastomoses [9], and abnormal umbilical artery (UA) Doppler waveforms [6][7][8][9][10][12][13][14] are preoperative risk factors for IUFD. Abnormal UA Doppler waveforms, defined as persistently absent (AEDV) or reversed end-diastolic velocity (REDV), are typically seen in the donor twin [11][12][13]15].…”

Section: Introductionmentioning

confidence: 99%

“…Abnormal UA Doppler waveforms, defined as persistently absent (AEDV) or reversed end-diastolic velocity (REDV), are typically seen in the donor twin [11][12][13]15]. Previous studies have demonstrated that 41-67% of donors with preoperative AEDV undergo IUFD after SLPCV [7,12,16]. In an earlier study, we found that, among patients with persistent AEDV, patients who had at least 30% of the donor's cardiac cycle spent in AEDV were more likely to undergo IUFD of the donor after laser surgery for TTTS [16].…”

Section: Introductionmentioning

confidence: 99%

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Percent Absent End-Diastolic Velocity in the Umbilical Artery and Donor Twin Demise after Laser Surgery for Twin-Twin Transfusion Syndrome

et al. 2020

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Introduction: To examine the association of preoperative absent end-diastolic velocity (AEDV) and percent AEDV (%AEDV) in the umbilical artery (UA) with donor twin intrauterine fetal demise (IUFD) after laser surgery for twin-twin transfusion syndrome (TTTS). Methods: We performed a retrospective study of stage III/IV TTTS patients who underwent laser surgery from 2006 to 2016. Donors were classified as having preoperative persistent AEDV (yes/no). %AEDV was calculated for those with AEDV as 100× the proportion of the total cardiac cycle in AEDV. Using multiple logistic regression, we tested for an association between the outcome donor IUFD and AEDV risk factors (part 1) and %AEDV (part 2). We stratified these analyses by estimated fetal weight (EFW) discordance ≥20 versus < 20%. Results: Of 344 cases, 153 (44.5%) donors had AEDV. Part 1 did not confirm an independent association between AEDV and donor IUFD. In the part 2 analysis of the 153 patients with AEDV, %AEDV was a posi-tive risk factor for donor IUFD only in those with discordance (n = 129) (OR 1.04, 95% CI 1.01-1.08, p = 0.0278) when adjusting for %EFW discordance, presence of arterioarterial anastomoses, and multiparity. Discussion: Among stage III/IV TTTS patients with AEDV, %AEDV was a risk factor for donor IUFD only in the presence of EFW discordance.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: 1125mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Percent Absent End-Diastolic Velocity in the Umbilical Artery and Donor Twin Demise after Laser Surgery for Twin-Twin Transfusion Syndrome

et al. 2020

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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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Dual demise following laser surgery for twin‐twin transfusion syndrome: Analysis of 52 cases at a single fetal surgery center

et al. 2021

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Objective To evaluate all individual cases of dual twin demise following laser surgery for twin‐twin transfusion syndrome (TTTS). Method This is an analysis of all monochorionic diamniotic twin gestations with TTTS complicated by dual demise following laser surgery from 2006 to 2019. Cases were reviewed by (1) a fetal surgeon researcher and (2) a panel of independent experienced maternal‐fetal medicine specialists to code an etiology of demise for the donor and recipient, and to assess for possible preventability. Results Of 753 twins that underwent laser surgery for TTTS, 52 (6.9%) had postoperative dual demise. In this subgroup, gestational age at surgery was 19.5 (16.1–24.9) weeks, and 36 (69.2%) patients were Quintero stage III and IV. The most common etiology was the spectrum of disorders leading to preterm delivery, which included cervical insufficiency, preterm premature rupture of membranes, and preterm labor (44.2% and 48.1%, donor and recipient, respectively). Some degree of preventability was estimated for 23.1% of dual demises. Conclusions The most common cause of dual demise post laser surgery for TTTS was preterm birth, reinforcing the need for studies regarding the etiology and prevention of post‐fetoscopy prematurity. Nearly one‐quarter of dual demise cases were deemed potentially preventable.

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Risk of donor demise after laser therapy for twin–twin transfusion when complicated by growth discordance and abnormal umbilical artery Doppler findings*

Cited by 13 publications

References 22 publications

Percent Absent End-Diastolic Velocity in the Umbilical Artery and Donor Twin Demise after Laser Surgery for Twin-Twin Transfusion Syndrome

Percent Absent End-Diastolic Velocity in the Umbilical Artery and Donor Twin Demise after Laser Surgery for Twin-Twin Transfusion Syndrome

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

Dual demise following laser surgery for twin‐twin transfusion syndrome: Analysis of 52 cases at a single fetal surgery center

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