2095290 Sonography Interval and Diagnosis of Twin-Twin Transfusion Syndrome

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To evaluate the relationship between sonographic surveillance for twin-twin transfusion syndrome (TTTS) and gestational age and stage at diagnosis. We reviewed monochorionic diamniotic pregnancies with TTTS followed with serial sonography at a single institution from 1997 to 2013. All sonogram images were reviewed by an investigator to confirm Quintero stage. Gestational age and stage were compared in those diagnosed at initial sonogram or at a subsequent sonogram either within or >14 days from a prior exam. TTTS was diagnosed in 48 pregnancies, 50% at the 1st, 19% at the 2nd, and 31% at or after the 3rd sonogram. Overall, 50% were stage I, 10% stage II, 29% stage III, and 10% stages IV or V at diagnosis. Those diagnosed at initial sonogram developed disease earlier than those diagnosed during a subsequent exam, 21.4±3.6 weeks vs 25.1±4.3 weeks, P=0.001, but there was no difference in TTTS stage at diagnosis, P=0.2. Among those diagnosed during a follow-up sonogram, 29% had isolated oligohydramnios and 17% isolated hydramnios at the sonogram preceding diagnosis. Isolated fluid abnormalities were more common if the prior exam was within 14 days than if >14 days, 70% vs. 21%, P=0.01. Stage III was more likely to be diagnosed ≤14 days from a prior sonogram than with longer scanning interval, P=0.04 (Table), otherwise there was no difference in TTTS stage at diagnosis in relation to sonogram interval. TTTS stage did not differ whether the diagnosis was made at an initial or subsequent sonogram. Sonography interval >14 days was not associated with more advanced stage at diagnosis. Isolated oligohydramnios or hydramnios on prior ultrasound was associated with shorter interval to diagnosis, reflecting increased surveillance for fluid abnormalities.Tabled 1Sonography Interval and Diagnosis of TTTSDiagnosed at Initial SonogramSonogram Interval ≤ 14 daysSonogram Interval > 14 daysStagen (%)Gestational Age, weeksn (%)Gestational Age, weeksn (%)Gestational Age, weeksI11 (46)21.23 (30)24.810 (71)27.3II4 (17)21.11 (10)26.10-III6 (25)20.56 (60)22.32 (14)23.0IV1 (4)25.50-2 (14)24.7V2 (8)23.20-0- Open table in a new tab