title: Outcomes of stage I TTTS or liquor discordant twins: a single-centre review.
abstract: OBJECTIVE
  To investigate rates of progression, regression and stabilisation and outcomes for stage I twin-twin transfusion syndrome (TTTS) and significant liquor discordant (LD) monochorionic diamniotic (MCDA) twins referred to the New South Wales Fetal Therapy Centre between June 2007 and May 2013.
  
  
  METHODS
  Retrospective cohort study of 329 monochorionic referrals, of whom 47 had LD and 28 had stage I TTTS at presentation; 43 were stage I or higher at any time during surveillance. Clinical progression, rates of therapy, survival and associated complications were evaluated.
  
  
  RESULTS
  Of stage I cases, 64% (18/28) remained stable or regressed, with 60% (6/10) of those progressing becoming at least stage II within 2 weeks. Of LD cases, 7/47 (15%) progressed to stage I TTTS, 8/47 (17%) to stage II or higher and 3/47 (6%) to selective intrauterine growth restriction (38% total).
  
  
  CONCLUSIONS
  While a stable clinical picture was the most common outcome in stage I/LD presentations, progression to stage ≥ II TTTS occurred in 36 and 17% respectively, indicating that LD is not a benign finding. Rapid progression in the majority of progressive cases and modest overall survival rates support close surveillance of these pregnancies and investigation of laser therapy as a first-line treatment of stage I TTTS. © 2016 John Wiley & Sons, Ltd.
authors.affiliation: School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Ellen
authors.initials: E
authors.lastname: Hinch
authors.affiliation: School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.|Department of Maternal Fetal Medicine, Royal Hospital for Women, Sydney, New South Wales, Australia.
authors.forename: Amanda
authors.initials: A
authors.lastname: Henry
authors.affiliation: School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Isabella
authors.initials: I
authors.lastname: Wilson
authors.affiliation: School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.|Department of Maternal Fetal Medicine, Royal Hospital for Women, Sydney, New South Wales, Australia.
authors.forename: Alec W
authors.initials: AW
authors.lastname: Welsh
mesh_terms: D000328:Adult; D000653:Amniotic Fluid; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005317:Fetal Growth Retardation / Q000453:epidemiology*; D005330:Fetofetal Transfusion / Q000401:mortality* / Q000628:therapy; D006801:Humans; D017075:Laser Coagulation; D009517:New South Wales; D011247:Pregnancy; D059285:Pregnancy, Twin; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D014430:Twins, Monozygotic