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. 2019 Jul 3;8(7):969.
doi: 10.3390/jcm8070969.

Twin-Twin Transfusion Syndrome with and without Selective Fetal Growth Restriction Prior to Fetoscopic Laser Surgery: Short and Long-Term Outcome

Sophie G Groene  1 , Lisanne S A Tollenaar  2 , Jeanine M M van Klink  3 , Monique C Haak  2 , Frans J C M Klumper  2 , Johanna M Middeldorp  2 , Dick Oepkes  2 , Femke Slaghekke  2 , Enrico Lopriore  3
Affiliations

Twin-Twin Transfusion Syndrome with and without Selective Fetal Growth Restriction Prior to Fetoscopic Laser Surgery: Short and Long-Term Outcome

Sophie G Groene et al. J Clin Med. .

Abstract

As twin-twin transfusion syndrome (TTTS) and selective fetal growth restriction (sFGR) are both prevalent complications of monochorionic (MC) twin pregnancies, its coexistence is not uncommon. The aim of this study is to evaluate the short and long-term outcome in TTTS with and without sFGR prior to fetoscopic laser coagulation. All TTTS cases treated with laser surgery at our center between 2001-2019 were retrospectively reviewed for the presence of sFGR, defined as an estimated fetal weight (EFW) <10th centile. We compared two groups: TTTS-only and TTTS + sFGR. Primary outcomes were perinatal survival and long-term severe neurodevelopmental impairment (NDI). Of the 527 pregnancies eligible for analysis, 40.8% (n = 215) were categorized as TTTS-only and 59.2% (n = 312) as TTTS + sFGR. Quintero stage at presentation was higher in the TTTS + sFGR group compared to the TTTS-only group (57% compared to 44% stage III). Separate analysis of donors showed significantly lower perinatal survival for donors in the TTTS + sFGR group (72% (224/311) compared to 81% (173/215), p = 0.027). Severe NDI at follow-up in long-term survivors in the TTTS-only and TTTS + sFGR group was present in 7% (13/198) and 9% (27/299), respectively (p = 0.385). Both sFGR (OR 1.5;95% CI 1.1-2.0, p = 0.013) and lower gestational age at laser (OR 1.1;95% CI 1.0-1.1, p = 0.001) were independently associated with decreased perinatal survival. Thus, sFGR prior to laser surgery is associated with a more severe initial presentation and decreased donor perinatal survival. The long-term outcome was not affected.

Keywords: neurodevelopmental outcome; selective fetal growth restriction; survival; twin-twin transfusion syndrome.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Flowchart of study inclusion. TTTS: Twin-twin transfusion syndrome, MC: Monochorionic, EFW: Estimated fetal weight, TAPS: Twin anemia-polycythemia sequence, sFGR: Selective fetal growth restriction.
Figure 2
Figure 2
Pictures of injected placentas after birth, both treated with laser surgery, illustrating the placental share division of the individual fetuses: (a) Placenta of a TTTS-only case; (b) placenta of a TTTS + sFGR case.
Figure 3
Figure 3
Flowchart of available long-term follow-up for analysis.
See this image and copyright information in PMC

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