title: Improved recipient survival with maternal nifedipine in twin-twin transfusion syndrome complicated by TTTS cardiomyopathy undergoing selective fetoscopic laser photocoagulation.
abstract: 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.
authors: 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
authors: Timothy M
authors: TM
authors: Crombleholme
authors: Foong-Yen
authors: FY
authors: Lim
authors: Mounira
authors: M
authors: Habli
authors: William
authors: W
authors: Polzin
authors: Ronald
authors: R
authors: Jaekle
authors: Erik
authors: E
authors: Michelfelder
authors: James
authors: J
authors: Cnota
authors: Chunyan
authors: C
authors: Liu
authors: Mi-Ok
authors: MO
authors: Kim
mesh_terms: 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*
chemical_list: D014665:Vasodilator Agents; D009543:Nifedipine