Perinatal and long‐term outcome of endoscopic laser surgery for twin–twin transfusion syndrome with and without selective fetal growth restriction: A retrospective cohort study

Abstract

Objective: Report survival rates, neonatal mortality and morbidity and long-term outcomes of monochorionic (MC) twin pregnancies complicated by twin-to-twin transfusion syndrome (TTTS) or TTTS plus selective fetal growth restriction (sFGR) treated by endoscopic laser surgery. Methods:Retrospective cohort study including 149 MC twin pregnancies complicated by TTTS or TTTS plus sFGR.Medical records were reviewed for survival rates, neonatal mortality, neonatal morbidity and long-term outcomes at 2 and 6 years of age.Results: Survival of both babies was higher in the TTTS group than in the TTTS plus sFGR group (72.9%vs.54.8%); survival of at least one baby was similar in the two groups (90.7% and 88.1%). The incidence of severe neurological disability was not significantly different between TTTS and TTTS plus fetal growth restriction group at both stages, 1.9% versus 2.3% (p-value = 1) and 3.4%vs6.1% (p-value = 0.31).Multivariable analysis demonstrated that intact neurological outcome at 2 years of age was related with gestational age (GA) at birth and z score birthweight (Z BW), and at 6 years of age with GA at birth, Z BW and TTTS stage4. sFGR or abnormal brain findings at neonatal ultrasound were not related with impaired neurological outcome at two or 6 years of age. Conclusions:In pregnancies with TTTS and TTTS plus sFGR survival of at least one baby and long-term neurological outcome are comparable between both groups. Key points What's already known about this topic?� The rate of neurodevelopmental impairment among monochorionic (MC) twins is higher than in dichorionic twins and singletons � Limited data suggest that neurodevelopmental outcome of fetuses with selective fetal growth restriction is worse than that of the normally growing co-twin.

Outcome following laser surgery of twin–twin transfusion syndrome complicated by selective fetal growth restriction: systematic review and meta‐analysis

“…Of these, 886 (51.8% (range, 28.2–65.3%)) pregnancies were complicated by sFGR. The incidence of sFGR in the included studies ranged from 28% in the study by Gibbone et al 28 . to 65% in the study by Van Winden et al 32 …”

“…Of these, 886 (51.8% (range, 28.2-65.3%)) pregnancies were complicated by sFGR. The incidence of sFGR in the included studies ranged from 28% in the study by Gibbone et al 28 to 65% in the study by Van Winden et al 32 . Table S3 compares the main pregnancy and disease characteristics between MCDA pregnancies affected by TTTS complicated by sFGR with those not complicated by sFGR.…”

“…A total of 1045 articles were identified, 16 were assessed with respect to their eligibility for inclusion and five studies were included in the systematic review (Table 1, Figure 1 and Table S2) [28][29][30][31][32] . After removing the studies that included overlapped cases, these five studies included 1710 MCDA twin pregnancies complicated by TTTS undergoing laser surgery.…”

“…Assessment of neonatal and long-term outcome was also challenging and was affected by potential bias. Only two studies with different types of postnatal assessment explored the long-term outcome of twin pregnancies with sFGR coexisting with TTTS, and we could perform a pooled analysis on the outcome only at 2 years of age, which may be insufficient to delineate the actual neurological outcome 28,31 . Another limitation of the present review lies in the fact that we could not stratify the analysis according to severity of sFGR.…”

Fetal growth disorders in twin gestations

“…In a cohort of 492 TTTS cases undergoing laser ablation, cases complicated by FGR had no differences in overall donor survival when compared with those without FGR; however, a combination of intertwin growth difference greater than 37% and severe FGR with the donor (EFW <1st percentile) was the best predictor of donor demise [46]. In a smaller cohort of 152 TTTS cases undergoing laser, survival of both babies was lower in the 42 cases, which were complicated by FGR (72.9 vs. 54.8%) [47].…”