511: The outcome of twin twin transfusion syndrome(TTTS) complicated with placental insufficiency

Abstract

ObjectiveTTTS has a high rate of perinatal morbidity and mortality ranging from 30 % to 80%. Literature is scant about the outcome of TTTS pregnancies complicated with fetal growth restriction /placental insufficiency. The aim is to evaluate neonatal outcomes of TTTS complicated with placental insufficiency(PI).Study designA retrospective chart review of TTTS pregnancies complicated by PI. PI is defined as fetal growth <10% with elevated head circumference /abdominal circumference ratio in the donor twin. Staging and diagnosis of TTTS were made according to the Cincinnati modification of Quintero system. Abnormal Doppler findings defined as absent or reverse diastolic flow in the umbilical artery(UA), reverse flow in ductus venosus(DV), or umbilical venous (UV) pulsation.Results34 pregnancies met criteria. Stage at presentation:3 stage I, 4 stage II, 24 stage III(2 III, 14 IIIA, 7 IIIB, 1IIIC), 3 stage IV. 11 with early stages were treated with amnioreduction, 17 with selective fetoscopic laser photocoagulation,more severe cases (n=4) with donor intrafetal radiofrequency ablation(RFA), and 2 declined treatment. There was a high incidence of abnormal placental cord insertion in the donor twin(16 marginal,11 membranous,1 vilemantous). Doppler abnormalities at time of diagnosis were more common in the donor (table). The survival rate of recipient was 88%(n=30/34) as compared to 70%(n=21/30) for donor(4 RFA selected donors were excluded).Tabled 1n=34Gestational age (GA) at diagnosis-wks20.1 ± 2.6GA at delivery-wks30.3 ± 4.6Abnormal DV Doppler -n(%)R5 (15)D11 (32)Abnormal UA Doppler -n(%)R3 (9)D22 (65)Abnormal UV Doppler -n(%)R9 (26)D17 (50)*Date (Mean±SD). Open table in a new tab ConclusionPlacental insufficiency impacts donor survival in TTTS. ObjectiveTTTS has a high rate of perinatal morbidity and mortality ranging from 30 % to 80%. Literature is scant about the outcome of TTTS pregnancies complicated with fetal growth restriction /placental insufficiency. The aim is to evaluate neonatal outcomes of TTTS complicated with placental insufficiency(PI). TTTS has a high rate of perinatal morbidity and mortality ranging from 30 % to 80%. Literature is scant about the outcome of TTTS pregnancies complicated with fetal growth restriction /placental insufficiency. The aim is to evaluate neonatal outcomes of TTTS complicated with placental insufficiency(PI). Study designA retrospective chart review of TTTS pregnancies complicated by PI. PI is defined as fetal growth <10% with elevated head circumference /abdominal circumference ratio in the donor twin. Staging and diagnosis of TTTS were made according to the Cincinnati modification of Quintero system. Abnormal Doppler findings defined as absent or reverse diastolic flow in the umbilical artery(UA), reverse flow in ductus venosus(DV), or umbilical venous (UV) pulsation. A retrospective chart review of TTTS pregnancies complicated by PI. PI is defined as fetal growth <10% with elevated head circumference /abdominal circumference ratio in the donor twin. Staging and diagnosis of TTTS were made according to the Cincinnati modification of Quintero system. Abnormal Doppler findings defined as absent or reverse diastolic flow in the umbilical artery(UA), reverse flow in ductus venosus(DV), or umbilical venous (UV) pulsation. Results34 pregnancies met criteria. Stage at presentation:3 stage I, 4 stage II, 24 stage III(2 III, 14 IIIA, 7 IIIB, 1IIIC), 3 stage IV. 11 with early stages were treated with amnioreduction, 17 with selective fetoscopic laser photocoagulation,more severe cases (n=4) with donor intrafetal radiofrequency ablation(RFA), and 2 declined treatment. There was a high incidence of abnormal placental cord insertion in the donor twin(16 marginal,11 membranous,1 vilemantous). Doppler abnormalities at time of diagnosis were more common in the donor (table). The survival rate of recipient was 88%(n=30/34) as compared to 70%(n=21/30) for donor(4 RFA selected donors were excluded).Tabled 1n=34Gestational age (GA) at diagnosis-wks20.1 ± 2.6GA at delivery-wks30.3 ± 4.6Abnormal DV Doppler -n(%)R5 (15)D11 (32)Abnormal UA Doppler -n(%)R3 (9)D22 (65)Abnormal UV Doppler -n(%)R9 (26)D17 (50)*Date (Mean±SD). Open table in a new tab 34 pregnancies met criteria. Stage at presentation:3 stage I, 4 stage II, 24 stage III(2 III, 14 IIIA, 7 IIIB, 1IIIC), 3 stage IV. 11 with early stages were treated with amnioreduction, 17 with selective fetoscopic laser photocoagulation,more severe cases (n=4) with donor intrafetal radiofrequency ablation(RFA), and 2 declined treatment. There was a high incidence of abnormal placental cord insertion in the donor twin(16 marginal,11 membranous,1 vilemantous). Doppler abnormalities at time of diagnosis were more common in the donor (table). The survival rate of recipient was 88%(n=30/34) as compared to 70%(n=21/30) for donor(4 RFA selected donors were excluded). *Date (Mean±SD). ConclusionPlacental insufficiency impacts donor survival in TTTS. Placental insufficiency impacts donor survival in TTTS.