Objective: To investigate whether perioperative fetal hemodynamic changes in twinto-twin transfusion syndrome (TTTS) are associated with neurodevelopmental impairment (NDI) at two years.Methods: Doppler parameters of three sonograms (day before, first day after and 1 week after laser surgery for TTTS) were assessed for correlation with neurodevelopmental outcome at two years (2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016). NDI was defined as: cerebral palsy, deafness, blindness, and/or a Bayley-III cognitive/motor developmental testscore > 2SD below the mean.Results: Long-term outcome was assessed in 492 TTTS survivors. NDI was present in 5% (24/492). After adjustment for severe cerebral injury (present in 4%), associated with NDI were: middle cerebral artery peak systolic velocity (MCA-PSV) >1.5 multiples of the median (MoM) 1 day after surgery (odds ratio [OR] 4.96; 95% confidence interval [CI]:1.17-21.05, P = .03), a change from normal umbilical artery pulsatility index (UA-PI) presurgery to UA-PI >p95 postsurgery (OR 4.19; 95% CI: 1.04-16.87, P = .04), a change from normal to MCA-PSV >1.5MoM (OR 4.75; 95% CI: 1.43-15.77, P = .01). Conclusion: Perioperative fetal hemodynamic changes in TTTS pregnancies treated with laser are associated with poor neurodevelopmental outcome. Prospective research on the cerebrovascular response to altered hemodynamic conditions is necessary to further understand the cerebral autoregulatory capacity of the fetus in relation to neurodevelopmental outcome.

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Oral communication abstractsResults: In Group 1 with expectant management 8 cases (47.1%) had have a favorable outcome, in 5 cases (29.4%) were spontaneous cessation of blood flow in the umbilical vessels in acardiac-twin. There were 9 patients (52.9%) with adverse outcome in Group 1 -in 3 cases (17.6%) were unpredictable demise of the pump-twin before 16 weeks, in 6 cases were progression of heart failure and polyhydramnios. The mean gestational age at delivery in Group 1 was 32.3 ± 5.4 weeks. 28 patients (Group 2) underwent fetal surgery. There were 22 pump-twin survivors (78.6%) and in 6 cases (21.4%) -adverse outcome. The mean gestational age at delivery in Group 2 was 34.5 ± 3.1 weeks. Conclusions: The loss rate of the pump-twin was significantly different between Group 1 and 2 (9 of 17 vs 6 of 22; P<0.005). In Group 2 the rate of preterm delivery before 36 weeks was significantly lower and gestational age at birth as well as birth weight were significantly higher than in Group 1. Fetal surgery offers an effective treatment option for the TRAP sequence with survival rate of 78.6%