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Fetus

Poster Session 2

(415) Fetoscopic laser outcomes for twin-twin transfusion syndrome with or without concomitant selective fetal growth restriction

Tuesday, February 13, 2024
3:30 PM – 5:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Fetal growth discordance (FGD) and selective fetal growth restriction (sFGR), which often accompany twin-twin transfusion syndrome (TTTS), are caused by discordant placental territories. The objective of this study was to determine the impact of FGD and sFGR on survival following fetoscopic laser surgery for the primary diagnosis of TTTS.

Study Design: This was a retrospective cohort study of cases of fetoscopic laser performed for TTTS in monochorionic diamniotic twin pregnancies in the North American Fetal Therapy Network (NAFTNet) Complicated MC Twin Registry. FGD was defined as a ≥25% weight discordance and sFGR as FGD with one fetus >10th percentile for gestational age (GA). Exclusion criteria were loss to follow-up, selective termination, monoamniotic pregnancies and triplet or higher order multiples. Primary outcome was fetal survival and secondary outcomes were GA at delivery and fetal complications.

Results: 2880 pregnancies were identified in the registry, of which 1194 were excluded. Of the 1686 pregnancies who were included for analysis, 688 had FGD and 377 qualified as sFGR. The table shows the pre-laser ultrasound evaluation. Dual survival was 75.15% in TTTS only, 62.50% in the TTTS+FGD and 61.01% in TTTS+sFGR (p< 0.001). Donor survival was 86.24%, 69.72% and 67.90% respectively (p< 0.001). Compared to TTTS alone, odds ratios for dual survival were 0.546 (0.442-0.675) in TTTS+FGD and 0.540 (0.421-0.692) in TTTS+sFGR. Odds ratios for donor survival were 0.367 (0.288-0.468) and 0.384 (0.292-0.506) respectively. Results remained statistically significant after adjusting for TTTS stage, Doppler anomalies and GA at laser. GA at delivery did not differ between groups. Fetal complications occurred in 2.56% of the TTTS-only group, 3.05% of the TTTS+FGD and 4.51% of the TTTS+sFGR.

Conclusion: Fetal dual survival is affected by the presence of FGD, even without sFGR, at the expense of the smaller twin.