Neonatal Outcomes and Maternal Characteristics in Monochorionic Diamniotic Twin Pregnancies: Uncomplicated versus Twin-to-Twin Transfusion Syndrome Survivors after Fetoscopic Laser Surgery

Fetal Diagn Ther. 2020;47(2):165-170. doi: 10.1159/000500858. Epub 2019 Aug 21.

Abstract

Preterm birth remains a major complication of fetal laser surgery (FLS) due to twin-to-twin transfusion syndrome (TTTS).

Objectives: We tested the hypothesis that neonatal outcomes in fetuses born at >24 weeks are worse in TTTS survivors compared to uncomplicated monochorionic diamniotic (MCDA) twins.

Methods: 196 patients with TTTS treated with laser therapy and 91 uncomplicated MCDA gestations were compared. Neonatal outcomes included respiratory distress syndrome (RDS), transient tachypnea of the newborn (TTN), bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis, and neonatal death. Risk factors assessed were TTTS, maternal age, maternal body mass index, race, premature prolonged rupture of membranes, stage of TTTS, parity, and gestational age (GA) at delivery.

Results: GA at delivery was lower in the TTTS group (31.0 ± 4.6 vs. 33.5 ± 2.4 weeks, p < 0.001). RDS and TTN occurred at higher rates in the TTTS than in the uncomplicated MCDA group. After multivariate logistic regression, the only factor significantly associated with the composite adverse outcome was GA at delivery (OR 0.61; 95% CI: 0.58-0.7).

Conclusion: TTTS twins treated with FLS are deliver 2.5 weeks earlier than uncomplicated MCDA twins. Respiratory complications were significantly higher in TTTS twins and were mainly the consequence of the early GA at delivery.

Keywords: Fetal surgery; Perinatal outcome; Twin-to-twin transfusion syndrome.

Publication types

  • Comparative Study
  • Twin Study

MeSH terms

  • Adult
  • Bronchopulmonary Dysplasia / etiology
  • Databases, Factual
  • Female
  • Fetofetal Transfusion / diagnostic imaging
  • Fetofetal Transfusion / mortality
  • Fetofetal Transfusion / physiopathology
  • Fetofetal Transfusion / surgery*
  • Fetoscopy* / adverse effects
  • Fetoscopy* / mortality
  • Gestational Age
  • Humans
  • Infant, Premature
  • Laser Therapy* / adverse effects
  • Laser Therapy* / mortality
  • Pregnancy
  • Premature Birth / etiology
  • Randomized Controlled Trials as Topic
  • Respiratory Distress Syndrome, Newborn / etiology
  • Risk Factors
  • Transient Tachypnea of the Newborn / etiology
  • Treatment Outcome
  • Twins, Conjoined*
  • Twins, Monozygotic*
  • Young Adult

Supplementary concepts

  • Respiratory Distress Syndrome In Premature Infants