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Fetus

Poster Session 1

(137) Outcomes of twin patients referred for shunt placement: a single institution’s 16-year experience

Tuesday, February 13, 2024
10:30 AM – 12:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Fetal shunt placement in twins remains controversial due to technical difficulties and potential procedure-related risks to the healthy co-twin. We report outcomes following referral for possible shunt placement in twins.

Study Design: Retrospective case series of twin gestations referred for shunt placement at a single center (2007-2023). Conditions eligible for shunt placement included: cystic fetal lung lesions or pleural effusion(s) with secondary fetal hydrops, and genitourinary (GU) tract obstruction with oligohydramnios. Results are reported as n (%) or median (range).

Results:

Among the 20 patients referred for possible shunt surgery, 4 were not eligible [chest lesion without hydrops (n=2), GU obstruction without oligohydramnios (n=2)]. Of the 16 eligible patients, 14 underwent shunt placement (9 GU, 5 thoracic) and 2 elected expectant management (2 GU). Gestational age (GA) at initial surgery was 21.9 (17.7-33.7) weeks. Four (28.6%) patients underwent a second procedure for displaced shunt. No intraoperative complications (e.g., incidental septostomy) occurred. Latency from initial surgery to delivery was 12.3 (2.43-20.0) weeks. Pregnancy outcomes are described in the Figure. Delivery GA was 33.2 (28.6-37.9) weeks in shunted patients vs. 35.5 (29.7-37.6) for all non-operative referred patients. All 20 unaffected co-twins were 30-day survivors. Twelve (85.7%) shunted twins were 30-day survivors with 100% co-twin 30-day survival. Significant co-twin prematurity related morbidity after shunting was rare (necrotizing enterocolitis and late onset sepsis after 28 and 34-week preterm births, respectively). Non-operative anomalous and healthy co-twin 30-day survival was 2 (50%) and 5 (100%), respectively.

Conclusion:

Shunt placement in twins meeting surgical criteria can be accomplished with relatively minimal risk to the co-twin. Well-counseled patients with twin gestations should not be excluded from undergoing fetal shunt placement at experienced centers.