Abundant research has been conducted regarding patients with TTTS who underwent fetal therapy, i.e., laser surgery, amnioreduction, and umbilical cord occlusion. Here, we describe patients referred for TTTS who did not undergo fetal therapy.METHODS:
TTTS gestations at 16-26 weeks referred between 1/2006 and 3/2017 were reviewed. Those who did not undergo fetal therapy comprised the final study population. Based on initial consultation data, patients were grouped as non-surgical vs. surgical candidates. TTTS progression and perinatal outcomes were assessed.RESULTS:
734 TTTS patients were evaluated. Of these, 68 (9.3%) did not undergo intervention; 42 non-surgical candidates (62%) and 26 surgical candidates (38%). Of the non-surgical candidates, 21 were ineligible because of fetal demise and 21 were ineligible because of maternal factors (12: preterm labor or preterm premature rupture of membranes, 7: placental abruption, 2: severe membrane separation). Of the surgical candidates, 11 underwent expectant management without subsequent intervention, 8 elected pregnancy termination, and 7 planned fetal intervention but had a complication before the procedure. Of 66 untreated cases, 10 (15.2%) had TTTS disease progression. Neonatal outcomes were available in 64 untreated cases: 41 (64%) had no survivors, 11 (17.2%) had one survivor and 12 (18.8%) had two survivors.CONCLUSION:
9% of referred TTTS patients did not undergo fetal therapy, with many ineligible because of the development of fetal demise or labor onset between referral and consultation. To avoid bias, studies tracking outcomes of TTTS should routinely acknowledge this subgroup and the circumstances leading to lack of treatment.