title: Donor Death After Selective Fetoscopic Laser Surgery for Twin-Twin Transfusion Syndrome.
abstract: OBJECTIVE
  To assess the incidence, timing, and risk factors for death of the donor fetus after fetoscopic laser surgery, we evaluated our cohort of patients who underwent the procedure for twin-twin transfusion syndrome.
  
  
  METHODS
  This was a prospective cohort study of 166 consecutive patients with twin-twin transfusion syndrome at a single center. Fetal death was diagnosed by ultrasonography after surgery and before onset of labor. Risk factors for death of the donor twin were identified on univariate analysis and then subjected to multivariate, stepwise, logistic regression analysis.
  
  
  RESULTS
  Donor demise occurred in 20 (13%) cases and recipient twin death occurred in four (2.6%). The median procedure to death interval was 4 days (range 1-89 days). Risk factors for donor death were fetal growth discordance greater than 30% (odds ratio [OR] 6.7, 95% confidence interval [CI] 2-23), reverse end-diastolic velocity in the donor umbilical artery (OR 25.0, 95% CI 2-290), a marginal and velamentous cord insertion (OR 4.4, 95% CI 1-19), and an increased number of anastomoses (OR 1.2, 95% CI 1.1-1.5). All four donors with both fetal growth discordance greater than 30% and reverse end-diastolic velocity in the donor umbilical artery resulted in a demise.
  
  
  CONCLUSIONS
  Four risk factors significantly affecting acute and delayed donor demise after fetoscopic laser surgery were identified. The presence of both fetal growth discordance greater than 30% and reverse end-diastolic velocity in the donor umbilical artery was highly predictive of donor demise in our cohort. Knowledge of these risk factors can aid in counseling and assist patients in choosing the most appropriate intervention in the management of twin-twin transfusion syndrome.
  
  
  METHODS
  III.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology and Reproductive Sciences, University of Texas Health-University of Texas Medical School, and The Fetal Center at Children's Memorial Hermann Hospital, Houston, Texas.
authors.forename: Saul
authors.initials: S
authors.lastname: Snowise
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Moise
authors.forename: Anthony
authors.initials: A
authors.lastname: Johnson
authors.forename: Michael W
authors.initials: MW
authors.lastname: Bebbington
authors.forename: Ramesha
authors.initials: R
authors.lastname: Papanna
mesh_terms: D000328:Adult; D005260:Female; D005313:Fetal Death / Q000209:etiology*; D005330:Fetofetal Transfusion / Q000401:mortality / Q000601:surgery*; D005332:Fetoscopy / Q000379:methods / Q000401:mortality*; D006801:Humans; D016015:Logistic Models; D015999:Multivariate Analysis; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome