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Oral Concurrent Session 9 - Fetal US Genetics

Oral Concurrent Sessions

(87) Preoperative Predictors of Survival in Twin-Twin Transfusion Syndrome Undergoing Fetoscopic Laser Treatment

Wednesday, February 14, 2024

3:30 PM – 3:45 PM

Location: Potomac Ballroom D, Ballroom Level

Primary & Presenting Author(s)

Henry L. Galan, MD

Professor, Department of OB/GYN
University of Colorado, School of Medicine; Colorado Fetal Care Center
Aurora, Colorado, United States

Coauthor(s)

Michael V. Zaretsky, MD (he/him/his)

Professor, Department of OB/GYN
University of Colorado, School of Medicine
Aurora, CO, United States

Disclosure(s): I have no relevant financial relationships to report.
NB

Nicholas Behrendt, MD

University of Colorado, School of Medicine
Aurora, CO, United States
ZP

Zhaoxing Pan, PhD

Associate Professor
University of Colorado, School of Medicine, School of Public Health
Aurora, CO, United States
Anthony Johnson, DO

Professor
McGovern Medical School at UTHealth Houston
Houston, TX, United States
Greg Ryan, MBBS

Head, Fetal Medicine program & Ontario Fetal Centre
Sinai Health Center
Toronto, ON, Canada
WG

William Goodnight, MD, MSCR

UNC Hospitals
Chapel Hill, NC, United States

Objective: Limited data exist regarding the influence of preoperative risk factors (PreopRF) on survival for patients undergoing fetoscopic laser photocoagulation (FLP) for twin-twin transfusion syndrome (TTTS). The objective of this study was to determine preoperative variables predictive of single and dual survival at birth for those subjects treated with FLP for TTTS.

Study Design: TTTS pregnancies treated with FLP between 2001-2023 were identified through an international complicated monochorionic twin pregnancy registry (North American Fetal Therapy Network) containing maternal, obstetric, fetal/newborn outcomes, and multiple PreopRF (BMI, gestational age (GA) at FLP, selective fetal growth restriction (sFGR) < 10^th and < 3^rd percentiles, cervical length (CL) < < 25 and < 15mm, anterior placental location (AP), cardiomyopathy markers, and Quintero TTTS stage). Higher order multiples, fetal anomalies and karyotypic abnormalities were excluded. Predictive rates of single/dual survival based on PreopRF and uni- and multivariate regression analyses were performed with p < 0.05 taken as significant.

Results: Of 2728 TTTS cases treated with FLP, 1066 met inclusion criteria. Sequential addition of any Preop RF progressively reduces survival of 1 or 2 twins (Figure 1a) or 2 twins (Figure 1b). Figure 1c shows progressive reduction in predicted survival rates for 1 or 2 twins or 2 twins based on individual and combinations of PreopRF. After uni- and multivariate analyses, the only Preop RF with significant reductions in survival were CL < 25mm for 1 or 2 twins and AP location for 2 twins. Compared to stage I & 2 TTTS, only dual survival is reduced in stage 3 & 4 disease (OR 1.32: 1.02, 1.71; p=0.032)

Conclusion:

In this large registry, a CL < 25mm was the most predictive PreopRF reducing survival for one or both twins, while AP location was most predictive in reducing survival for both twins. As the number of PreopRF increases for a given TTTS case, there is a progressive reduction in survival. Calculated survival rates based on the presence of one or more PreopRF is useful in the counseling of patients with TTTS.