Outcomes of stage I TTTS or liquor discordant twins: a single-centre review.

Abstract

To investigate rates of progression, regression and stabilisation and outcomes for stage I twin-twin transfusion syndrome (TTTS) and significant liquor discordant (LD) monochorionic diamniotic (MCDA) twins referred to the New South Wales Fetal Therapy Centre between June 2007 and May 2013. Retrospective cohort study of 329 monochorionic referrals, of whom 47 had LD and 28 had stage I TTTS at presentation; 43 were stage I or higher at any time during surveillance. Clinical progression, rates of therapy, survival and associated complications were evaluated. Of stage I cases, 64% (18/28) remained stable or regressed, with 60% (6/10) of those progressing becoming at least stage II within 2 weeks. Of LD cases, 7/47 (15%) progressed to stage I TTTS, 8/47 (17%) to stage II or higher and 3/47 (6%) to selective intrauterine growth restriction (38% total). While a stable clinical picture was the most common outcome in stage I/LD presentations, progression to stage ≥ II TTTS occurred in 36 and 17% respectively, indicating that LD is not a benign finding. Rapid progression in the majority of progressive cases and modest overall survival rates support close surveillance of these pregnancies and investigation of laser therapy as a first-line treatment of stage I TTTS. © 2016 John Wiley & Sons, Ltd.