Fetal Diagnosis and Therapy
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Article / Publication Details
Abstract
Introduction: To determine if outcomes of fetoscopic laser photocoagulation in isolated twin-twin transfusion syndrome (TTTS) differ from TTTS with concomitant selective fetal growth restriction (sFGR).
Methods: This is a retrospective cohort study of all cases of TTTS treated at the CHU Sainte-Justine between February 2006 and January 2020. Data was collected from maternal, obstetrical and neonatal chart review.
Results: A total of 149 patients were included in our study. Forty-seven patients (31.5%) had a pregnancy complicated by TTTS and sFGR. Mean gestational age at diagnosis and at treatment was 20+4 weeks and 20+6 weeks for TTTS alone, and 20+5 weeks and 21+2 weeks with concomitant sFGR. The presence of concomitant sFGR negatively impacted survival. Double survival (DS) in the TTTS + sFGR was 48.9% (23/47) vs 68.6% (70/102) in the TTTS-only group (p=0.021). Fetal donor survival was 59.6% (28/47) in the TTTS + sFGR group and 84.3% (86/102) in the TTTS-only group (p=0.001). However, the survival of at least one twin did not differ between the two groups: 93.6% (44/47) in the TTTS + sFGR group vs 92.2% (94/102) in the TTTS-only group (p=0.751). The presence of type 2-3 sFGR (OR=0.56; 95%CI 0.32-0.96, p=0.033) and gestational age at laser therapy (OR1.17; 95%CI 1.01=1.36, p=0.036) were independently associated with dual survival.
Conclusion: Selective fetal growth restriction is independently associated with decreased double survivorship at the expense of the donor in TTTS undergoing laser therapy. Type 2 or 3 sFGR and early gestational age at treatment are especially at risk. A larger cohort is needed to validate our results.
S. Karger AG, Basel
Article / Publication Details
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