OP26.05: Differences in prognostic factors of single fetal demise after laser therapy for Twin–twin transfusion syndrome between early and late fetal demise

Abstract

Single fetal demise (SD) occurs after laser therapy in 15–20% of twin pregnancies, with approximately 60% of cases occurring within a week after laser therapy. However, in some cases, SD occurs later than 14 days after laser therapy. The objective of this study was to elucidate whether the prognostic factors of SD after laser therapy for Twin–twin transfusion syndrome (TTTS) differ depending on the period of SD. We conducted a retrospective study on patients with monochorionic diamniotic (MCDA) twin pregnancies diagnosed with TTTS and treated with laser therapy at a single tertiary centre between 2007 and 2015. SD occurring within 14 days after laser therapy was defined as early SD (E-SD), and SD occurring later than 14 days after laser therapy as late SD (L-SD). In study 1, we defined the group of both twins alive on postoperative day 14 as the control group for E-SD. In study 2, we defined the group of both twins alive at 28 days old after birth as the control group for L-SD. We evaluated the prognostic factors associated with E-SD and L-SD after laser therapy separately, dividing the twins into donors and recipients. Between 2007 and 2015, 145 pregnancies were diagnosed with TTTS and treated with laser therapy. SD occurred in 34 cases (24.1%), involving 26 donors (18.4%) and 8 recipients (5.7%). E-SD and L-SD occurred in 25 (73.5%) and 9 pregnancies (26.5%), respectively. Multivariable logistic regression analysis revealed that the independent risk factors of donor E-SD were the presence of arterioarterial anastomoses (odds ratio [OR], 11.1; 95% confidence interval [CI], 2.7–45.9); p = 0.001) and marginal cord insertion (OR, 4.7; 95% CI, 1.3–17.5); p = 0.022), and that of donor L-SD was postoperative umbilical artery reversed-end diastolic velocity in the donor (OR, 120; 95% CI, 3.9–3687; p = 0.006). We found that the prognostic factors of SD after laser therapy for TTTS differed depending on the period of SD in the donor.