Preoperative predictors of death in twin-to-twin transfusion syndrome treated with laser ablation of placental anastomoses.
OBJECTIVE
To determine preoperative predictive factors for donor and recipient death after laser ablation of placental vessels in twin-to-twin transfusion syndrome.


METHODS
Retrospective analysis of North American Fetal Therapy Network center laser procedures, 2002-2009. Factors associated with donor and recipient death were identified by regression analysis.


RESULTS
There were 466 patients from 8 centers. Factors significantly associated with donor fetal death were low donor estimated fetal weight (odds ratio [OR], 0.69; 95% confidence interval [CI], 0.55-0.87) and reversed end diastolic velocity in the umbilical artery (OR, 4.0; 95% CI, 1.54-10.2); for recipient fetal death-low recipient estimated fetal weight (OR, 0.65; 95% CI, 0.44-0.95), recipient reversed "a" wave in the ductus venosus (OR, 2.39; 95% CI, 1.27-4.51) and hydrops (OR, 3.7; 95% CI, 1.1-12.7); for recipient neonatal death-low donor estimated fetal weight (OR, 0.54; 95% CI, 0.30-0.95), high recipient estimated fetal weight (OR, 1.55; 95% CI, 1.06-2.26) and recipient reversed end diastolic velocity in the umbilical artery (OR, 7.8; 95% CI, 1.03-59.3).


CONCLUSIONS
Preoperative findings predict fetal and neonatal demise in twin-to-twin transfusion syndrome treated with laser therapy.
Skupski
Daniel W
DW
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Weill Cornell College of Medicine, New York, NY, USA.
Luks
Francois I
FI
Walker
Martin
M
Papanna
Ramesha
R
Bebbington
Michael
M
Ryan
Greg
G
O'Shaughnessy
Richard
R
Moldenhauer
Julie
J
Bahtiyar
Ozan
O
D001163:Arteriovenous Anastomosis / Q000601:surgery*; D001783:Blood Flow Velocity / Q000502:physiology; D005260:Female; D005313:Fetal Death / Q000209:etiology*; D020567:Fetal Weight; D005330:Fetofetal Transfusion / Q000601:surgery*; D005332:Fetoscopy; D006801:Humans; D015160:Hydrops Fetalis / Q000453:epidemiology; D053685:Laser Therapy; D016015:Logistic Models; D010920:Placenta / Q000098:blood supply / Q000601:surgery*; D011247:Pregnancy; D018607:Pregnancy Reduction, Multifetal; D057234:Preoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000503:physiopathology