WS13: Multiple pregnancy WS13‐01The effect of treatment of twin‐to‐twin transfusion syndrome on the diagnosis to delivery interval

Abstract

PurposeNo randomized controlled trials of treatment of twin‐to‐twin transfusion syndrome (TTTS) exist. Since severely preterm neonatal survival has increased over time, survival as an outcome measure is confounded by calendar time. The diagnosis‐to‐delivery interval is a calendar year independent measure of success of treatment. We wished to evaluate whether treatment of TTTS is associated with a lengthening of the diagnosis‐to‐delivery interval.MethodsMEDLINE search supplemented by careful reference review. All TTTS series were included where the following information on each patient was available: survival, fetal demise, gestational age (GA) at diagnosis and diagnosis to delivery interval in days.Inclusion criteriaGA ≤ 29 weeks and diagnosis by ultrasound in the absence of maternal symptoms. Cases undergoing multiple types of treatment were excluded. Data were evaluated by Kruskal–Wallis anova, logistic regression & Wilcoxon rank sum testing.ResultsThe 8 publications used included the following cases: controls (n = 16), amnioreduction (n = 61), septostomy (n = 12), and fetoscopic laser occlusion of chorioangiopagus vessels (FLOC) (n = 51). FLOC therapy showed a significantly longer diagnosis‐to‐delivery interval compared to amnioreduction (median 75 vs. 56 days) (p = 0.01). There was no difference in overall survival, at least one survivor, or number of fetal deaths between the 4 groups. Logistic regression using at least one survivor as the dependent variable revealed a positive association with GA at diagnosis and with diagnosis to delivery interval, a negative correlation with fetal death, and no correlation with treatment group.ConclusionsFLOC therapy for TTTS is associated with a longer diagnosis‐to‐delivery interval compared to amnioreduction without a significant increase in survival. The lack of increase in survival appears to be due to a small sample size.