Prediction of neonatal outcome of TTTS by fetal heart and Doppler ultrasound parameters before and after laser treatment.
OBJECTIVE
To determine the prognostic value of fetal Doppler and echocardiographic parameters for neonatal survival up to 30 days after laser coagulation in monochorionic pregnancies complicated by twin-twin transfusion syndrome (TTTS).


METHODS
Fetal echocardiography and outcome data of consecutive cases of TTTS treated by laser were retrospectively reviewed. Hemodynamic and cardiac function parameters were collected before and after laser.


RESULTS
Between February 2006 and January 2015, 106 fetoscopic laser were performed. The final analysis was limited to cases with ultrasound within 2 days before laser (n = 77) and 4 weeks after laser (n = 86). Overall neonatal survival rate was 64.9% (135/208) and 77.9% of pregnancies (81/104) had at least one baby alive. For the recipient twin, the preoperative predictors of neonatal survival were umbilical artery (UA) pulsatility index (PI), cerebro-placental PI ratio, UA end diastolic flow (EDF), ductus venosus a-wave, right ventricular myocardial performance index (RV-MPI) and CHOP score. The postoperative predictors of donor survival were donor RV-MPI and recipient UA EDF, umbilical vein pulsations, tricuspid regurgitation, cardiac hypertrophy and CHOP score.


CONCLUSIONS
The hemodynamic predictors of postnatal survival after laser were preoperative signs of recipient cardiomyopathy and postoperative signs of cardiac overload in both twins. © 2016 John Wiley & Sons, Ltd.
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, CHU Sainte-Justine, University of Montreal, Quebec, Canada.
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Delabaere
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, CHU Sainte-Justine, University of Montreal, Quebec, Canada.
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Leduc
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, CHU Sainte-Justine, University of Montreal, Quebec, Canada.
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Reboul
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, CHU Sainte-Justine, University of Montreal, Quebec, Canada.
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Fuchs
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, CHU Sainte-Justine, University of Montreal, Quebec, Canada.
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Wavrant
Fetal Cardiology Unit, Pediatric Cardiology, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Quebec, Canada.
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Fouron
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, CHU Sainte-Justine, University of Montreal, Quebec, Canada.
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Audibert
D004452:Echocardiography; D005260:Female; D005318:Fetal Heart / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005330:Fetofetal Transfusion / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D005332:Fetoscopy; D005865:Gestational Age; D006801:Humans; D017075:Laser Coagulation; D011247:Pregnancy; D011379:Prognosis; D011673:Pulsatile Flow; D012189:Retrospective Studies; D016896:Treatment Outcome; D014427:Twins; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000503:physiopathology