Twin twin transfusion syndrome with and without selective fetal growth restriction: Predictors of donor demise.

Abstract

Evaluate survival in twin twin transfusion syndrome (TTTS) with and without selective fetal growth restriction (sFGR) after fetoscopic laser surgery (FLS). Retrospective study of monochorionic diamniotic twins undergoing FLS. The cohort was classified as TTTS and TTTS with sFGR. Baseline, intra-operative and postoperative variables were analyzed. Mann-Whitney U, Pearson chi-square, Fisher's exact, t-test and receiver operating characteristic (ROC) curve analysis were performed. Four hundred and ninety-two pregnancies were included, 304 (61.78%) TTTS and 188 (38.22%) TTTS with sFGR. No difference in donor outcomes. TTTS group had higher donor estimated fetal weight (EFW%) percentile (19.7±18.8 vs. 2.2±2.1, p<0.001). Significant predictors for demise at 30days were 37% intertwin weight discordance (IWD) with donor EFW%<first (area under ROC curve [AUC]=0.85, p=0.001) or IWD >25% and intertwin umbilical artery pulsatility index discordance (DUAPI) ≥0.4 (AUC=0.71, p=0.001). Combination of IWD of 37% and donor EFW% <first was most predictive for demise 30days after birth. DUAPI ≥0.4 was also associated with increased risk for demise.