Objective Twin anemia-polycythemia sequence (TAPS) can occur as a unique disease or as a complication of twin-twin transfusion syndrome (TTTS).

What are the novel findings of this work?Utilization of the Delphi contributory criteria for defining selective fetal growth restriction (sFGR) in pregnancies with twin-twin transfusion syndrome classifies more cases as having sFGR compared to other definitions. This definition also had the highest predictive value for donor twin demise following fetoscopic laser surgery for twin-twin transfusion syndrome. What are the clinical implications of this work?Standardization of the definition of sFGR should enable more consistent prediction of outcome. Not only does this influence our management decisions with regard to fetal surveillance, but it also enhances patient care and counseling, especially in cases requiring surgical management.

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Following FLS for TTTS, a lower incidence of rTTTS/TAPS was seen when the Solomon technique was used, as well as when a 10-Fr or 12-Fr cannula was used. A lower complication rate may be due to the use of a scope with better optics during placental mapping. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

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Objective To evaluate the association of laser photocoagulation of placental anastomoses (LPA) prior to 18 weeks' gestation (early LPA) with very preterm delivery and neonatal survival in pregnancies with twin–twin transfusion syndrome (TTTS). Methods This was a retrospective cohort study of monochorionic diamniotic twin pregnancies with TTTS undergoing LPA between 2002 and 2018 at two institutions. The rates of delivery < 28, < 30 and < 32 weeks' gestation, preterm prelabor rupture of membranes (PPROM) and 30‐day survival of one or both infants were compared between pregnancies undergoing early LPA and those undergoing LPA ≥ 18 weeks' gestation. Regression analysis was performed to determine the association of early LPA with very preterm delivery and 30‐day survival, adjusted for Quintero stage, study phase, selective fetal growth restriction, gestational age at delivery, maternal age ≥ 35 years, body mass index > 35 kg/m2, placental location, use of Seldinger method to place the operative trocar, size of the trocar, participating center, use of Solomon technique, cerclage and PPROM. Survival analysis using the Cox proportional hazard model was applied to examine the LPA‐to‐delivery interval according to the timing of surgery, adjusted for confounding variables. Results A total of 414 TTTS pregnancies were included in the study, of which 68 (16.4%) underwent early LPA. In the total cohort, the incidence of delivery at < 28, < 30 and < 32 weeks' gestation was 22.7%, 39.6% and 53.4%, respectively. Survival of both twins and survival of at least one twin at 30 days were 67.5% and 90.8%, respectively. No significant difference was noted between pregnancies that underwent early LPA and those that had LPA ≥ 18 weeks in the rate of delivery < 28 weeks (19.1% vs 23.4%; P = 0.4), < 30 weeks (38.2% vs 39.9%; P = 0.8) and < 32 weeks (44.1% vs 55.2%; P = 0.1) and PPROM (29.0% vs 24.1%; P = 0.4), or in the incidence of double‐twin survival (63.9% vs 68.1%; P = 0.5) and survival of at least one infant (91.8% vs 90.6%; P = 0.7) at 30 days. Early LPA was not associated with very preterm delivery or neonatal survival in the regression analyses. Early LPA was associated with a longer LPA‐to‐delivery interval compared with LPA performed ≥ 18 weeks (median, 106.9 days (range, 2–164 days) vs median, 69.3 days (range, 0–146 days); P < 0.001) when adjusted for confounding variables (hazard ratio, 2.56 (95% CI, 1.76–3.73); P < 0.001). Conclusion Laser surgery before 18 weeks is not associated with an increased rate of very preterm delivery and PPROM or with reduced neonatal survival when compared with LPA after 18 weeks. © 2020 International Society of Ultrasound in Obstetrics and Gynecology

What are the novel findings of this work? Among fetuses with twin-twin transfusion syndrome (TTTS) treated with fetoscopic laser photocoagulation, those with later gestational age (GA) at the time of laser surgery, earlier GA at delivery and lower birth weight were found to be at increased risk of developing neurodevelopmental impairment (NDI) in early childhood. However, no significant association was found between Quintero stage of TTTS and risk of NDI. What are the clinical implications of this work?Clarification of the perinatal risk factors of NDI can be useful in clinical practice for parental counseling and identification of TTTS survivors at risk of developing NDI in future life.