title: Doppler assessment of patients with twin-to-twin transfusion syndrome and survival following fetoscopic laser surgery.
abstract: OBJECTIVE
  To investigate fetal-survival rates following laser surgery for twin-to-twin transfusion syndrome (TTTS) and the impact of Doppler analysis.
  
  
  METHODS
  The present retrospective single-center study included data from patients with pregnancies exhibiting TTTS treated with fetoscopic laser surgery between January 1, 2007, and December 31, 2016. Perinatal outcomes were examined and variables were compared between the donor and recipient fetuses that survived and died, respectively.
  
  
  RESULTS
  There were 86 pregnancies exhibiting TTTS treated with fetoscopic laser surgery included in the study. The median length of pregnancy at the time of surgery was 21.1 weeks. Both twin fetuses and at least one fetus survived in 61 (71%) and 73 (85%) pregnancies, respectively. Among recipient fetuses, ductus venosus a-wave anomalies (P=0.026), shorter cervical length (P=0.044), and a greater than 25% discrepancy in the estimated weight of the twin fetuses (P=0.045) were associated with reduced survival.
  
  
  CONCLUSIONS
  Among pregnancies exhibiting TTTS, laser surgery was associated with significant dual-fetus survival. Preoperative ductus venosus anomalies were associated with lower survival among recipient fetuses, and 1-week postsurgical ultrasonography data demonstrated lower survival among recipient fetuses with persistent anomalous ductus venosus compared with normalized ductus venosus.
authors.affiliation: The Center for Fetal, Cellular and Molecular Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.|Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University Hospital of Granada (CHUG), Granada, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Gil Guevara
authors.affiliation: Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University Hospital of Granada (CHUG), Granada, Spain.
authors.forename: Andrea
authors.initials: A
authors.lastname: Pazos
authors.affiliation: Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University Hospital of Granada (CHUG), Granada, Spain.
authors.forename: Otilia
authors.initials: O
authors.lastname: Gonzalez
authors.affiliation: Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University Hospital of Granada (CHUG), Granada, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Carretero
authors.affiliation: Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University Hospital of Granada (CHUG), Granada, Spain.
authors.forename: Francisca S
authors.initials: FS
authors.lastname: Molina
mesh_terms: D005260:Female; D005330:Fetofetal Transfusion / Q000000981:diagnostic imaging* / Q000601:surgery*; D005332:Fetoscopy; D006801:Humans; D007231:Infant, Newborn; D017075:Laser Coagulation; D010920:Placenta / Q000098:blood supply / Q000000981:diagnostic imaging / Q000601:surgery*; D011247:Pregnancy; D012189:Retrospective Studies; D016019:Survival Analysis; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal
keywords: Doppler ultrasonography; Fetoscopic laser surgery; Monochorionic pregnancy; Twin-to-twin transfusion syndrome