985 Influence of gestational age of treatment of twin-twin transfusion syndrome on latency-to-delivery and outcomes

Abstract

The average latency to delivery after selective fetoscopic laser photocoagulation (SFLP) for treatment of pregnancies complicated by twin-twin transfusion syndrome (TTTS) has been reported as 10 weeks. We sought to determine the influence of the gestational age (GA) at the time of SFLP on latency to delivery and neonatal survival in patients with TTTS. This was a retrospective cohort study evaluating latency to delivery and survival of infants after SFLP in pregnancies complicated by TTTS at a single center from 4/2010 to 6/2019. A total of 637 patient were included. Latency was evaluated for each week that SFLP was performed. Primary and secondary outcomes were compared between three groups (16 0/7-17 6/7, 18 0/7-22 6/7, and 23 0/7-28 6/7 weeks) at time of SFLP. Primary outcomes were latency to delivery and neonatal survival after SFLP. Secondary outcomes were postoperative and pregnancy complications after SFLP. Data were analyzed using linear regression, ANOVA, and Chi2 as appropriate. Advancing GA is inversely related to latency from SFLP to delivery (See figure). Latency to delivery was longer the earlier SFLP was performed, mean (±SD) of 11.7 (±4.9) weeks at 16 0/7-17 6/7 weeks, 10.2 (±4) weeks at 18 0/7-22 6/7 weeks, and 6.3 (±3.4) weeks at 23 0/7-28 6/7 weeks (Table 1). Linear regression demonstrated an inverse relationship (coefficient -0.73, R2 0.19, p<0.001). Composite complications were increased the earlier SFLP was performed 55.6%, 40.3%, and 30.8% at 16 0/7-17 6/7, 18 0/7-22 6/7, and 23 0/7-28 6/7 weeks respectively (p=0.001). Neonatal survival for at least one twin to day of life 30 was 85.6%, 92.3%, and 94.7% (p=0.042) and dual neonatal survival to day of life 30 was 67.0%, 79.2%, and 81.2% (p=0.02) for the same groups. SFLP performed at earlier gestational age demonstrates longer latency until delivery. Despite this, SFLP at earlier gestational age is associated with an increase in complications and decreased neonatal survival for one or both twins.View Large Image Figure ViewerDownload Hi-res image Download (PPT)