Improved recipient survival with maternal nifedipine in twin-twin transfusion syndrome complicated by TTTS cardiomyopathy undergoing selective fetoscopic laser photocoagulation.
OBJECTIVE
The purpose of this study was to evaluate the effect of maternal nifedipine on fetal survival when started 24-48 hours before selective fetoscopic laser photocoagulation (SFLP).


METHODS
We conducted a case control study of consecutive cases of twin-twin transfusion syndrome (TTTS) in which TTTS cardiomyopathy was treated with maternal nifedipine 24-48 hours before SFLP, compared with gestational age and stage-matched control cases. The primary outcome was recipient and donor survival.


RESULTS
One hundred forty-one cases of TTTS were treated with nifedipine, and 152 gestational age- and stage-matched control cases were analyzed. There was a significant increase in overall fetal survival in nifedipine-treated cases compared with control cases (237/284 [83%] vs 232/308 [75%]; P = .015). There is an increase in survival of recipients who were treated with nifedipine in stage IIIA (100% vs 81%; P = .021) and IIIB (93% vs 71%; P = .014); however, there was no difference in donor survival.


CONCLUSIONS
Maternal nifedipine is associated with improved recipient survival in TTTS that undergoes SFLP. This is the first study to suggest a benefit of adjunctive maternal medical therapy in patients with TTTS who undergo SFLP.
Crombleholme
Timothy M
TM
The Fetal Care Center of Cincinnati, Division of Pediatric General, Thoracic, and Fetal Surgery, Cincinnati Children's Hospital, Cincinnati, OH 45229-3039, USA. timothy.crombleholme@cchmc.org
Lim
Foong-Yen
FY
Habli
Mounira
M
Polzin
William
W
Jaekle
Ronald
R
Michelfelder
Erik
E
Cnota
James
J
Liu
Chunyan
C
Kim
Mi-Ok
MO
D009202:Cardiomyopathies / Q000175:diagnosis / Q000188:drug therapy*; D016022:Case-Control Studies; D005260:Female; D005330:Fetofetal Transfusion / Q000401:mortality* / Q000601:surgery*; D005332:Fetoscopy; D006801:Humans; D017075:Laser Coagulation; D009543:Nifedipine / Q000627:therapeutic use*; D011247:Pregnancy; D012720:Severity of Illness Index; D016019:Survival Analysis; D016216:Ultrasonography, Prenatal; D014665:Vasodilator Agents / Q000627:therapeutic use*
D014665:Vasodilator Agents; D009543:Nifedipine