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The outcome and prognostic factors of twin–twin transfusion syndrome following fetoscopic laser surgery
Author(s) -
Sago Haruhiko,
Hayashi Satoshi,
Saito Mari,
Hasegawa Hiromi,
Kawamoto Hiroshi,
Kato Naomi,
Nanba Yukiko,
Ito Yushi,
Takahashi Yuichiro,
Murotsuki Jun,
Nakata Masahiko,
Ishii Keisuke,
Murakoshi Takeshi
Publication year - 2010
Publication title -
prenatal diagnosis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.956
H-Index - 97
eISSN - 1097-0223
pISSN - 0197-3851
DOI - 10.1002/pd.2647
Subject(s) - ductus venosus , medicine , odds ratio , umbilical artery , retrospective cohort study , gestation , confidence interval , twin to twin transfusion syndrome , surgery , obstetrics , pregnancy , genetics , biology
Objectives To evaluate the outcome and preoperative risks of twin–twin transfusion syndrome (TTTS) following fetoscopic laser surgery (FLS). Methods A retrospective cohort study of a series of 181 consecutive cases of TTTS before 26 weeks' gestation subjected to FLS at four centers in Japan between July 2002 and December 2006. Results The chances of survival of at least one twin at 28 days of age and 6 months of age were 91.2% and 90.1%, respectively. The rate of major neurological complications in survivors at 6 months of age was 4.7%. Preoperative findings that were significant risk factors for death were as follows: (1) being donor [odds ratio (OR): 3.01, 95% confidence interval (CI): 1.24–7.31, P = 0.015]; (2) reversed (OR: 11.78, CI: 3.05–45.55, P < 0.001) and absent (OR: 3.95, CI: 1.66–9.43, P = 0.002) end‐diastolic velocity in the umbilical artery (EDV‐UA) of the donor; and (3) reversed blood flow in the ductus venosus of the recipient (OR: 2.35, CI: 1.04–5.29, P = 0.040). Conclusions FLS leads to high survival rates and low neurological morbidity for fetuses in TTTS. FLS is an effective therapeutic option for TTTS before 26 weeks of gestation. Preoperative Doppler findings of the umbilical artery and the ductus venosus are useful in predicting prognosis following FLS. Copyright © 2010 John Wiley & Sons, Ltd.