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Objective To determine risk factors for poor cognitive performance among children treated with in utero selective laser photocoagulation of communicating vessels for twin-twin transfusion syndrome (TTTS). Methods This was a prospectively enrolled cohort study. Cognitive performance at age 2 years (±6 weeks) was assessed via Battelle Developmental Inventory 2nd Edition (BDI-2). Multilevel regression models evaluated risk factors for poor cognitive performance at shared (“pregnancy”) and individual (“child”) levels. In addition to development, blindness, deafness and cerebral palsy were assessed based on physical exam. A priori power analysis determined that a sample of ≥100 children was required for adequate statistical power (0.80). Results 100 children (57 families) were evaluated. Total BDI-2 score was within normal range (mean=101.3, SD=12.2), with one child having a BDI-2 of <70. Individual child-level risk factors for lower BDI-2 included male sex (β=-0.37, p<0.01), lower head circumference (β=0.28, p<0.01), and higher diastolic blood pressure (β=-0.29, p<0.01). At the pregnancy level, lower maternal education (β=0.60, p<0.001), higher Quintero stage (β=-0.36, p<0.01), and lower GA at birth (β=0.30, p<0.01) were associated with worse cognitive outcomes. Donor/recipient status, GA at surgery, fetal growth restriction, and co-twin fetal demise were not risk factors. The rate of neurodevelopmental impairment (blindness, deafness, cerebral palsy, and/or a BDI-2 score <70) was 4%. Conclusion Overall cognitive performance quotients were in the normal range, with risk factors for poor outcomes seen at the pregnancy and child levels. Clinical and socio-economic characteristics can identify at-risk children needing additional interventions.

SIUGR, present in two-thirds of TTTS patients, was a risk factor for decreased donor survival. Patients with donor SIUGR and umbilical artery persistent or reversed end-diastolic flow (Quintero Stage III Donor-involved) were especially at risk.

Introduction: Incidental septostomy, or inadvertent perforation of the twins’ dividing membranes, can create a functional monoamniotic twin pregnancy. Our aim was to describe the perinatal outcomes and antenatal management of patients with incidental septostomy after laser surgery for twin-twin transfusion syndrome (TTTS). Materials and Methods: Monochorionic diamniotic multiple gestations with a gestational age (GA) between 16 and 26 weeks that underwent laser surgery from March 2006 to December 2015 were studied retrospectively. Perinatal outcomes were compared for patients with and without an incidental septostomy. A subgroup analysis was performed to evaluate antenatal management. Results: Of 532 TTTS patients who underwent laser surgery, incidental septostomy occurred in 34 (6.4%). Compared to all others, patients with a septostomy had an earlier median (range) GA at delivery (30.8 [18.6–37.9] vs. 34.0 [19.3–40.4] weeks, p < 0.0001) and lower 30-day survival of at least one twin (85.3 vs. 94.6%, p = 0.0452). We found no evidence that inpatient fetal surveillance was protective. Discussion: Incidental septostomy in TTTS patients treated via laser surgery appeared to be associated with lower GA at delivery and perinatal survival of at least one twin. Further study is required to determine the optimal antenatal surveillance strategy.