title: Perinatal survival in cases of twin-twin transfusion syndrome complicated by selective intrauterine growth restriction.
abstract: OBJECTIVE
  To evaluate the impact of selective intrauterine growth restriction (SIUGR) on monochorionic multiples treated with selective laser photocoagulation of communicating vessels (SLPCVs) for twin-twin transfusion syndrome (TTTS).
  
  
  METHODS
  Perinatal survival was compared among TTTS patients with and without SIUGR. The TTTS + SIUGR group was defined as TTTS patients with donor twin weight <10th percentile. Multivariable logistic regression analyses identified factors associated with 30-day survival.
  
  
  RESULTS
  Of 369 patients, 65% (N = 241) had TTTS + SIUGR. Thirty-day donor twin survival for the TTTS-only group was 84% versus 75% in the TTTS + SIUGR group (p = 0.0348). Stage III donor involved (stage III donor, donor/recipient) TTTS + SIUGR patients (N = 110) had 66% 30-day donor survival. Multivariable logistic regression demonstrated that the TTTS-only group was twice as likely to achieve donor survival compared to the TTTS + SIUGR group (OR 2.01, 95% CI 1.11-3.66, p = 0.0214). In the TTTS + SIUGR group, patients not classified as stage III donor-involved were twice as likely to achieve donor survival as stage III donor-involved patients (OR 2.02, 95% CI 1.10-3.71, p = 0.0226).
  
  
  CONCLUSIONS
  SIUGR, present in two-thirds of TTTS patients, was a risk factor for decreased donor survival. Patients with donor SIUGR and umbilical artery persistent or reversed end-diastolic flow (Quintero Stage III Donor-involved) were especially at risk.
authors.affiliation: a Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine , Keck School of Medicine, University of Southern California , Los Angeles , CA , USA and.
authors.forename: Kristi R
authors.initials: KR
authors.lastname: Van Winden
authors.forename: Rubén A
authors.initials: RA
authors.lastname: Quintero
authors.forename: Eftichia V
authors.initials: EV
authors.lastname: Kontopoulos
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Korst
authors.forename: Arlyn
authors.initials: A
authors.lastname: Llanes
authors.forename: Ramen H
authors.initials: RH
authors.lastname: Chmait
mesh_terms: D000328:Adult; D005260:Female; D005317:Fetal Growth Retardation / Q000401:mortality* / Q000601:surgery; D005330:Fetofetal Transfusion / Q000150:complications / Q000401:mortality* / Q000601:surgery; D005332:Fetoscopy / Q000379:methods; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D017075:Laser Coagulation / Q000379:methods; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D059285:Pregnancy, Twin; D016019:Survival Analysis; D014430:Twins, Monozygotic / Q000706:statistics & numerical data; D014469:Umbilical Arteries / Q000601:surgery; D055815:Young Adult
keywords: Fetal growth restriction; SIUGR; TTTS; fetoscopy; laser surgery; monochorionic