Obstetric and perinatal outcomes from the australian and new zealand twin-twin transfusion syndrome registry.
OBJECTIVE
Our purpose was to investigate the antepartum characteristics and perinatal outcomes of twin-twin transfusion syndrome cases from a multicenter national registry.


METHODS
Perinatal centers in Australia and New Zealand voluntarily notified a central evaluation registry with information on identified pregnancies with twin-twin transfusion syndrome during 1995 through 1998.


RESULTS
One hundred twelve cases of twin-twin transfusion syndrome were registered. The median gestation at diagnosis was 21.5 weeks (range, 14.4-34.6 weeks). Oligohydramnios-polyhydramnios sequence was the most common presentation, with 84% of cases involving "stuck" twinning. Therapeutic amnioreduction was used in 92 cases (82.1%), with the median number of procedures per case being 2 (range, 1-23). The median gestation at delivery was 29 weeks (range, 18-38 weeks). The overall perinatal survival rate was 62.5%. Abnormal findings on cranial ultrasonography were present in 27.3% of live neonates, and periventricular leukomalacia was reported in 10.8%. Increased gestational age at delivery, the presence of umbilical artery diastolic flow, and a prolonged interval from final amnioreduction to delivery were positively associated with the delivery of live fetuses without complications.


CONCLUSIONS
The majority of antenatally identified cases of twin-twin transfusion syndrome are managed with serial amnioreduction. Despite contemporary obstetric and neonatal management strategies, perinatal mortality and morbidity rates are high.
Dickinson
J E
JE
Department of Obstetrics and Gynaecology, University of Western Australia, Australia.
Evans
S F
SF
D001315:Australia; D001783:Blood Flow Velocity; D000013:Congenital Abnormalities / Q000453:epidemiology; D005260:Female; D005313:Fetal Death; D005330:Fetofetal Transfusion / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy; D005865:Gestational Age; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007969:Leukomalacia, Periventricular / Q000453:epidemiology; D009520:New Zealand; D007752:Obstetric Labor, Premature / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D012042:Registries; D014463:Ultrasonography; D014469:Umbilical Arteries / Q000000981:diagnostic imaging