88 Contemporary experience of management and outcomes of TTTS at NAFTNet Centers

Abstract

Describe the natural history, contemporary management, and outcomes of twin-twin transfusion syndrome at North American Fetal Therapy Network centers. Participating North American Fetal Therapy Network (NAFTNet) institutions developed a comprehensive registry for complicated monochorionic twin pregnancies (Jan 2000 – on-going). A de-identified REDCap registry was maintained by the study PI institution; prenatal, treatment and outcome data were collected for pregnancies complicated by unique MC pathology. For this analysis prenatal, diagnostic, treatment, and outcome data for the diagnosis of TTTS were abstracted. Descriptive statistics defined the population and Chisq was used to determine outcome based on initial stage. The diagnosis of TTTS and management were determined by the individual center. Data were accessed on 9/27/20. SPSS v26 was used for analysis. Of 3023 MC twin pregnancies from 26 North American fetal therapy centers, 2377(85.1%) are diagnosed with TTTS in the registry. The median (IQR) number of cases per institution is 48.5 (9.75, 166.25). The patient population was predominantly Caucasian (69.5%), parous (63.2%), and the median maternal age was 30.0 years (26.0, 34.0), with median BMI 27.0 (23.5, 31.7). The gestational age at TTTS diagnosis was 19.9 weeks (18.0, 21.9) and the median EGA at SLPC treatment was 20.3 weeks (18.6, 22.3). The interval from diagnosis at the fetal center to SLPC was 1.0 day (0.1, 1.3). In this data, most TTTS was treated with SLPC. The overall outcome was associated with the initial stage. Based on twins with complete data, overall survival at birth of one or both twins was 92.5% and at 6 months 86.4% with 70% of survivors without neonatal complications. This data demonstrates the contemporary North American experience for the management of TTTS at NAFTNet institutions. While unavailability of complete data for all patients limits the precision of the outcome estimates, this large single dataset, representative of the majority of treatment centers can provide generalizable outcome and benchmark data for management of TTTS.View Large Image Figure ViewerDownload Hi-res image Download (PPT)