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Twin-Twin Transfusion Syndrome with and without Selective Fetal Growth Restriction Prior to Fetoscopic Laser Surgery: Short and Long-Term Outcome

As twin-twin transfusion syndrome (TTTS) and selective fetal growth restriction (sFGR) are both prevalent complications of monochorionic (MC) twin pregnancies, its coexistence is not uncommon. The aim of this study is to evaluate the short and long-term outcome in TTTS with and without sFGR prior to...

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Autores principales: Groene, Sophie G., Tollenaar, Lisanne S. A., van Klink, Jeanine M. M., Haak, Monique C., Klumper, Frans J. C. M., Middeldorp, Johanna M., Oepkes, Dick, Slaghekke, Femke, Lopriore, Enrico
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6679158/
https://www.ncbi.nlm.nih.gov/pubmed/31277319
http://dx.doi.org/10.3390/jcm8070969
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author Groene, Sophie G.
Tollenaar, Lisanne S. A.
van Klink, Jeanine M. M.
Haak, Monique C.
Klumper, Frans J. C. M.
Middeldorp, Johanna M.
Oepkes, Dick
Slaghekke, Femke
Lopriore, Enrico
author_facet Groene, Sophie G.
Tollenaar, Lisanne S. A.
van Klink, Jeanine M. M.
Haak, Monique C.
Klumper, Frans J. C. M.
Middeldorp, Johanna M.
Oepkes, Dick
Slaghekke, Femke
Lopriore, Enrico
author_sort Groene, Sophie G.
collection PubMed
description As twin-twin transfusion syndrome (TTTS) and selective fetal growth restriction (sFGR) are both prevalent complications of monochorionic (MC) twin pregnancies, its coexistence is not uncommon. The aim of this study is to evaluate the short and long-term outcome in TTTS with and without sFGR prior to fetoscopic laser coagulation. All TTTS cases treated with laser surgery at our center between 2001–2019 were retrospectively reviewed for the presence of sFGR, defined as an estimated fetal weight (EFW) <10th centile. We compared two groups: TTTS-only and TTTS + sFGR. Primary outcomes were perinatal survival and long-term severe neurodevelopmental impairment (NDI). Of the 527 pregnancies eligible for analysis, 40.8% (n = 215) were categorized as TTTS-only and 59.2% (n = 312) as TTTS + sFGR. Quintero stage at presentation was higher in the TTTS + sFGR group compared to the TTTS-only group (57% compared to 44% stage III). Separate analysis of donors showed significantly lower perinatal survival for donors in the TTTS + sFGR group (72% (224/311) compared to 81% (173/215), p = 0.027). Severe NDI at follow-up in long-term survivors in the TTTS-only and TTTS + sFGR group was present in 7% (13/198) and 9% (27/299), respectively (p = 0.385). Both sFGR (OR 1.5;95% CI 1.1–2.0, p = 0.013) and lower gestational age at laser (OR 1.1;95% CI 1.0–1.1, p = 0.001) were independently associated with decreased perinatal survival. Thus, sFGR prior to laser surgery is associated with a more severe initial presentation and decreased donor perinatal survival. The long-term outcome was not affected.
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spelling pubmed-66791582019-08-19 Twin-Twin Transfusion Syndrome with and without Selective Fetal Growth Restriction Prior to Fetoscopic Laser Surgery: Short and Long-Term Outcome Groene, Sophie G. Tollenaar, Lisanne S. A. van Klink, Jeanine M. M. Haak, Monique C. Klumper, Frans J. C. M. Middeldorp, Johanna M. Oepkes, Dick Slaghekke, Femke Lopriore, Enrico J Clin Med Article As twin-twin transfusion syndrome (TTTS) and selective fetal growth restriction (sFGR) are both prevalent complications of monochorionic (MC) twin pregnancies, its coexistence is not uncommon. The aim of this study is to evaluate the short and long-term outcome in TTTS with and without sFGR prior to fetoscopic laser coagulation. All TTTS cases treated with laser surgery at our center between 2001–2019 were retrospectively reviewed for the presence of sFGR, defined as an estimated fetal weight (EFW) <10th centile. We compared two groups: TTTS-only and TTTS + sFGR. Primary outcomes were perinatal survival and long-term severe neurodevelopmental impairment (NDI). Of the 527 pregnancies eligible for analysis, 40.8% (n = 215) were categorized as TTTS-only and 59.2% (n = 312) as TTTS + sFGR. Quintero stage at presentation was higher in the TTTS + sFGR group compared to the TTTS-only group (57% compared to 44% stage III). Separate analysis of donors showed significantly lower perinatal survival for donors in the TTTS + sFGR group (72% (224/311) compared to 81% (173/215), p = 0.027). Severe NDI at follow-up in long-term survivors in the TTTS-only and TTTS + sFGR group was present in 7% (13/198) and 9% (27/299), respectively (p = 0.385). Both sFGR (OR 1.5;95% CI 1.1–2.0, p = 0.013) and lower gestational age at laser (OR 1.1;95% CI 1.0–1.1, p = 0.001) were independently associated with decreased perinatal survival. Thus, sFGR prior to laser surgery is associated with a more severe initial presentation and decreased donor perinatal survival. The long-term outcome was not affected. MDPI 2019-07-03 /pmc/articles/PMC6679158/ /pubmed/31277319 http://dx.doi.org/10.3390/jcm8070969 Text en © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Groene, Sophie G.
Tollenaar, Lisanne S. A.
van Klink, Jeanine M. M.
Haak, Monique C.
Klumper, Frans J. C. M.
Middeldorp, Johanna M.
Oepkes, Dick
Slaghekke, Femke
Lopriore, Enrico
Twin-Twin Transfusion Syndrome with and without Selective Fetal Growth Restriction Prior to Fetoscopic Laser Surgery: Short and Long-Term Outcome
title Twin-Twin Transfusion Syndrome with and without Selective Fetal Growth Restriction Prior to Fetoscopic Laser Surgery: Short and Long-Term Outcome
title_full Twin-Twin Transfusion Syndrome with and without Selective Fetal Growth Restriction Prior to Fetoscopic Laser Surgery: Short and Long-Term Outcome
title_fullStr Twin-Twin Transfusion Syndrome with and without Selective Fetal Growth Restriction Prior to Fetoscopic Laser Surgery: Short and Long-Term Outcome
title_full_unstemmed Twin-Twin Transfusion Syndrome with and without Selective Fetal Growth Restriction Prior to Fetoscopic Laser Surgery: Short and Long-Term Outcome
title_short Twin-Twin Transfusion Syndrome with and without Selective Fetal Growth Restriction Prior to Fetoscopic Laser Surgery: Short and Long-Term Outcome
title_sort twin-twin transfusion syndrome with and without selective fetal growth restriction prior to fetoscopic laser surgery: short and long-term outcome
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6679158/
https://www.ncbi.nlm.nih.gov/pubmed/31277319
http://dx.doi.org/10.3390/jcm8070969
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