WS07‐03Stage‐based treatment of twin–twin transfusion syndrome: preliminary study

Abstract

BackgroundThe purpose of this study was to test the value of sonographic staging of twin–twin transfusion syndrome (TTTS) in predicting the outcome of patients treated with amniocentesis or selective laser photocoagulation of communicating vessels (SLPCV).MethodsTTTS was defined as a deep vertical pocket (DVP) in the recipient twin of > 8 cm and in the donor twin < 2 cm. TTTS was staged as follows: Stage I: bladder of donor visible; Stage II: bladder of donor not visible; Stage III: critically abnormal Dopplers; Stage IV: hydrops; Stage V: demise. Patients were treated with amniocentesis or SLPCV.ResultsThere were a statistically significant difference by stage for at least one survivor between the two techniques (Chi‐square = 2.63, p = 0.05), but analysis was limited by sample size (amniocentesis n = 9, SLPCV n = 70). In the amniocentesis group there was an 83% (n = 5) survival rate for two survivors in Stage I and no survivors (n = 3) in stages II or III. In the SLPCV group, at least one fetus survived 83% of the time, regardless of stage.ConclusionOur preliminary data suggests that analysis of survival data by in TTTS needs stratification by stage. Early stages may be amenable to treatment with amniocentesis, while later stages may not benefit. SLPCV is uniformly effective, regardless of stage, but may not be warranted in early stages of TTTS.