Twin-Twin Transfusion Syndrome Confers Persistent Morbidity and Mortality: A Community-Based Cohort [26I]

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Abstract

INTRODUCTION:

Selective fetoscopic laser photocoagulation (SFLP) for pregnancies complicated by twin-twin transfusion syndrome (TTTS) has improved outcomes for this morbid condition. Our objective was to describe the obstetric and neonatal outcomes of pregnancies complicated by TTTS in a community-based cohort.

METHODS:

We retrospectively studied all diamniotic monochorionic (DiMo) twin sets evaluated between 2011–2014 at the perinatal center of Mercy Hospital St. Louis, a suburban referral center that performs 8,000 deliveries annually. Individual chart review was performed using our electronic health record.

RESULTS:

65 DiMo twin sets were identified. TTTS was diagnosed in 25 (38%) of DiMo pregnancies, of which 23 (92%) were Caucasian and 19 (76%) privately insured. TTTS severity by Quintero stage in N (%): 4 (16) stage 1, 4 (16) stage 2, 10 (42) stage 3, 2 (8) stage 4, 5 (21) stage 5. The gestational age at diagnosis was 19.5±4.6 weeks (mean±SD). One pregnancy was electively terminated. 9 (41%) pregnancies had demise of one or both fetuses and 2 (9%) had neonatal demise. Of pregnancies with a live birth, gestational age was 28±6 weeks (mean±SD) and 11 (44%) resulted in hospital discharge of two live infants. 13 (52%) patients underwent SLFP at outside centers, following which the following complications developed (n): demise of one twin (2), monoamnionicity (2), preterm labor (5), abruption (2), PPROM (7).

CONCLUSION:

Despite improving treatments for TTTS, obstetric outcomes for this condition in our high-resource community setting remain poor.

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