P20.15: Audit of immediate outcomes for MCDA twins following laser therapy for twin–twin transfusion syndrome at the NSW Fetal Therapy Center

Abstract

Electronic poster abstractsConclusions: Perinatal results of complicated DCT did not show differences according to surgical procedure performed. However, we acknowledge that the small simple size could prevent to find differences in our study. Therefore, further studies and multicenter are needed to evaluate risks and efficacy of these therapies in DCT. King Khalid University Hospital, Riyadh, Saudi Arabia; Liverpool Hospital, Sydney, NSW, Australia Objectives: The New South Wales Fetal Therapy Center (NSW FTC) has performed selective laser photocoagulation of communicating vessels (SLPCV) for twin-twin transfusion syndrome (TTTS) since July 2003. Our objectives were to audit the immediate pregnancy and neonatal outcomes of SLPCV for TTTS at our tertiary referral center. Methods: Retrospective cohort study. Outcome data for 147 TTTS cases that underwent SLPCV between July 2003 and May 2013 was reviewed. The outcomes measured included procedural details, delivery details and perinatal outcomes. Results: Median gestation at diagnosis was 20.3 weeks (IQR 18.6-22.0) and at SLPCV 20.4 weeks (IQR 19.1-22.4). 93.2% SLPCV cases were stage II-III and SLPCV was technically possible in 98.7%. For the 122 pregnancies for whom neonatal outcome data was available, dual survival to birth was 58.2% and survival of at least one baby was 89.3%. Survival of at least one twin to discharge was 84.9%. Median gestational age at delivery was 32 weeks . Median weight of liveborn babies was 1764g (IQR 1300g-2202g), with prematurity and RDS the most common neonatal complications. Most common immediate SLPCV complications were in-utero fetal demise within 1 week of the procedure and preterm premature rupture of membranes, which occurred in 19.6% and 11.6% of cases respectively. TTTS recurrence (1.3%) and TAPS (2.2%) were both uncommon. Conclusions: SLPCV remains the optimal treatment for stages II-IV TTTS prior to 26 weeks gestation. The outcomes of SLPCV at the NSW FTC compare favourably with international published literature, and have remained constant since our previous publication. The outcomes have remained stable following an initial learning curve, supporting the concentration of specialist skills within tertiary referral centers. P20.15 P20.16Congenital diaphragmatic hernia survival prediction in Chile Objectives: The predictive capacity has been questioned and it needed to be proven in different geographic setting, with different population and care. The objective was to evaluate lung volume with O/E LHR in Chile, double check with Leuven and report survival. Methods: Prospective evaluation of all CDH cases, since 2009 to date. All measures were obtained in Clinica Alemana (MY) and checked by the medical team from Leuven, in order to assured the image quality, and therefore, validate the method. Results: 39 pregnancies with CDH were evaluated, with 5 lost of follow-up and 2 with ongoing pregnancies. From 32 that were subject of analysis, there were 27 left and 5 right CDH. All evaluations were done between 24 and 32 weeks ...

Uncommon complications of monochorionic twin pregnancies: Twin anaemia-polycythaemia sequence

“…This may have contributed to the poor outcomes, particularly as TAPS fetuses may be quite sick at diagnosis with anaemia and polycythaemia. This differs from laser‐treated TTTS, in which fetuses usually either die in utero or survive closer to 34 weeks in relatively good condition . When compared to uncomplicated MCDA pregnancies, TAPS pregnancies clearly had a worse outcome, underscoring the potential severity of TAPS despite its later gestational onset.…”

“…In contrast to most prior reports, the majority of our TAPS cases were spontaneous rather than iatrogenic. This may be due to the relatively low proportion of iatrogenic TAPS at our centre . However, although both RANZCOG and ISUOG now recommend routine MCA Dopplers as part of fortnightly MCDA surveillance, until relatively recently many centres did not routinely perform MCA Dopplers on all MCDA twins, meaning iatrogenic: spontaneous ratios in existing literature may partly reflect diagnosis and referral bias.…”