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Ultrasound/Imaging

Poster Session 3

(771) TTTS Staging Stratification for Fetal Death with Donor Twin Middle Cerebral Artery Evaluation without TAPS

Wednesday, February 14, 2024
8:30 AM – 10:00 AM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: To determine the association of elevated ( > 1.5 MoMs) middle cerebral artery peak systolic velocity (MCA-PSV) with fetal demise in donor twins among twin-to-twin transfusion syndrome (TTTS) cases without twin anemia polycythemia sequence (TAPS)

Study Design: This prospective cohort study included TTTS cases that underwent laser surgery from 2011 to 2022 at a single center. The distribution of donor fetal demise was stratified according to TTTS staging and elevated donor MCA-PSV without TAPS. Regression analysis was done to determine the association of isolated increased donor MCA-PSV and fetal demise, adjusted for TAPS, TTTS stage, selective fetal growth restriction (sFGR), and other confounders (Table 1). A cox regression model was used to evaluate the association of elevated donor MCA-PSV without TAPS and surgery-to-delivery interval adjusting for confounders  

Results: Out of 660 TTTS cases, donor MCA-PSV was unavailable in 46 (7%) cases. Of the remaining 614 patients, 9 (1.5%) were lost to follow up. High donor MCA-PSV without TAPS was seen in 5.6% (34/605) of the study population and its frequency doubled with each TTTS stage (1.2%, 3.6%, 6.9%, and 16.7%; at stages I, II, III, and IV, respectively; p=0.003). Among donor fetal demise cases (n=85) the percentage of elevated donor MCA-PSV without TAPS was 0% (0/6), 7.1% (1/14), 22.6% (14/62), and 100% (3/3) at TTTS stages I, II, III, and IV, respectively (p=0.005). High donor MCA-PSV without TAPS was an independent factor for donor fetal demise (aOR: 10.7; 95 % CI: 4.84-23.6; p< 0.001), after adjusting for confounders (Table 1). Elevated donor MCA-PSV without TAPS was independently associated with shorter surgery-to-delivery interval (Hazard ratio: 0.38; 95% CI: 0.22-0.67)

Conclusion: Elevated donor MCA-PSV without TAPS prior to laser surgery is associated with shorter procedure-to-delivery interval and with an 11-fold increased risk for donor fetal demise, adjusted for TAPS, sFGR, TTTS stage, and other confounders. Doppler evaluation of donor MCA PSV prior to laser surgery can further stratify TTTS staging to evaluate the risk for donor fetal demise