Doppler for artery-artery anastomosis and stage-independent survival in twin-twin transfusion.
OBJECTIVE
Treatment selection in twin-twin transfusion syndrome is increasingly determined by disease severity. We investigated whether detection of arterio-arterial anastomoses predicts perinatal survival.


METHODS
An artery-artery anastomosis was sought by Doppler and disease stage was determined in 105 cases of twin-twin transfusion syndrome at presentation, first treatment, and worst stage. Outcome measures were perinatal, double, and any (1 or more babies) survival rates.


RESULTS
After exclusion of 10 noninformative pregnancies, perinatal, double, and any survival rates were 61%, 44%, and 77%, respectively. When an anastomosis was detected at each of the 3 time points, perinatal and double survival rates were higher than when one was not (at first treatment, perinatal survival 83% versus 53%, respectively, P =.003; double survival 78% versus 33%, P <.001). Perinatal and double survival (P < or =.01) were poorer with more advanced stage, but any survival rates were not influenced by stage or anastomosis detection. Multiple logistic regression demonstrated that anastomosis detection at treatment increased the chance of perinatal (odds ratio [OR] 5.1, 95% confidence interval [CI] 1.6, 15.9) and double survival (OR 19.3, 95% CI 2.7, 138), independently of stage. For stages I-III at treatment, anastomosis detection predicted better perinatal (100% versus 63%, 100% versus 59%, and 83% versus 44%, respectively) and double survival rates (100% versus 52%, 100% versus 46%, and 78% versus 26%). Stage III, with anastomoses detected, had better perinatal (83% versus 63%) and double survival (78% versus 52%) than did stage I without detection.


CONCLUSIONS
Antenatal detection of artery-to-artery anastomosis predicts higher perinatal and double survival in twin-twin transfusion syndrome, independently of disease stage.


METHODS
II-3
Tan
Tony Y T
TY
Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN, United Kingdom.
Taylor
Myles J O
MJ
Wee
Ling Y
LY
Vanderheyden
Tina
T
Wimalasundera
Ruwan
R
Fisk
Nicholas M
NM
D001159:Arterio-Arterial Fistula / Q000151:congenital* / Q000000981:diagnostic imaging*; D005260:Female; D005330:Fetofetal Transfusion / Q000000981:diagnostic imaging* / Q000401:mortality*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D016015:Logistic Models; D011237:Predictive Value of Tests; D011247:Pregnancy; D015996:Survival Rate; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal