Ultrasound prognostic factors after laser surgery for twin–twin transfusion syndrome to predict survival at 6 months

Abstract

Ultrasound risk factors one week after surgery included severe intrauterine growth restrictions and effusions in the donor twins.

Fetal Doppler changes 1 week after endoscopic equatorial laser for twin‐to‐twin transfusion syndrome: A longitudinal study

“…The preoperative finding of umbilical artery AREDF in TTTS donors can be considered as a sign of severe hypovolemia, placental insufficiency, or both . The coexistence of severe FGR was found to be an additional risk factor of donor's demise in previous studies . Our data showed that, among donors surviving at 1 week after laser treatment, the incidence of FGR was similarly high in the group with Doppler normalization and in cases with persistently abnormal findings (Table ), and that in 68% of growth restricted donors with prelaser Doppler abnormalities, there was normalization after treatment, suggesting a hypovolemic cause of preoperative findings in these cases more than a hypoxic mechanism.…”

“…18 The coexistence of severe FGR was found to be an additional risk factor of donor's demise in previous studies. 4,6,12,19 Our data showed that, among donors surviving at 1 week after laser treatment, the incidence of FGR was similarly high in the group with Doppler normalization and in cases with persistently abnormal findings ( Table 4), and that in 68% of growth restricted donors with prelaser Doppler abnormalities, there was normalization after treatment, suggesting a hypovolemic cause of preoperative findings in these cases more than a hypoxic mechanism. However, we cannot exclude that the lack of association between donor FGR and persistence of Doppler abnormalities may have also been influenced by the small sample size; therefore, future studies should investigate this finding further.…”

“…Only 2 previous studies assessed fetal Doppler findings at 1 week after laser treatment, which was conducted mainly using the selective technique and reported no significant association between postoperative abnormal umbilical artery Doppler and donor survival at 30 days and 6 months of age, respectively. 11,12 The main differences with our study are that firstly, we considered as the main outcome spontaneous IUFD, rather than postnatal survival, to remove other causes of death, Numbers are presented as n (%).…”

“…Preoperative Doppler abnormalities have been examined in relation to fetal survival, and most studies showed concordant results on the increased rate of donor demise in cases with AREDF in the umbilical artery . In contrast, several cross‐sectional studies have shown that abnormal donor umbilical artery Doppler and recipient ductus venosus flow, assessed in the postoperative period between 24 hours and 4 weeks after laser, were not significantly associated with an increased mortality . However, longitudinal assessment of fetal Doppler findings across the perioperative period and investigation into the possible causes for nonimprovement in fetuses surviving beyond the early postoperative phase have not been systematically conducted.…”

Doppler assessment of patients with twin‐to‐twin transfusion syndrome and survival following fetoscopic laser surgery

“…The main objective of fetoscopic laser surgery in TTTS is survival of both fetuses. Higher dual survival has been reported with Quintero stage I and II TTTS compared with Quintero stage III and IV TTTS . It is important to consider the prevalence of recipient‐fetus ductus venosus anomalies for preoperative counselling of patients because it affects survival in this group of twins substantially.…”