Long-term outcome in twin-twin transfusion syndrome treated with serial aggressive amnioreduction

Giancarlo Mari, Laura Detti, Utku Oz, Alfred Z. Abuhamad

Research output: Contribution to journalArticle

93 Citations (Scopus)

Abstract

OBJECTIVE: The purpose of this study was to determine long-term outcomes among pregnancies complicated by twin-twin transfusion syndrome and treated in a tertiary center with serial aggressive amnioreduction. STUDY DESIGN: Thirty-three pregnancies with a diagnosis of twin-twin transfusion syndrome were treated with ≥1 amnioreduction. The perinatal outcome was assessed according to 15 parameters, whereas the main outcome at age ≥2 years was the absence of cerebral palsy. RESULTS: Gestational age at diagnosis ranged from 14.5 to 33 weeks’ gestation (median, 20.6 weeks’ gestation), whereas gestational age at delivery was between 18.5 and 37 weeks’ gestation (median, 30.5 weeks’ gestation). The number of amnioreductions per pregnancy ranged from 1 to 15 (median, 2). At initial examination hydrops of the recipient and absence of the end-diastolic velocity of the umbilical artery in one of the twins were associated with poor prognosis. Fifty-one (77%) twins were born alive. At 24 months after birth both infants from 57% of the pregnancies (19/33) were alive, whereas at least one infant from 70% of the pregnancies (23/33) was alive. Thirty-three infants (78% of the survivors) were older than 36 months at last follow-up. Cerebral palsy was diagnosed in 2 of 42 infants (4.7%). One of the affected infants was born after the fetal death of the cotwin; the other infant was born with congenital cardiac malformations. CONCLUSIONS: In the group of fetuses in which both twins were delivered alive after 27 weeks' gestation without congenital malformations and survived the neonatal period, no major neurologic handicaps developed in any of the infants. At initial examination both hydrops of the recipient and absence of end-diastolic flow velocity waveforms of the umbilical artery in one of the twins were poor prognostic signs.

Original languageEnglish (US)
Pages (from-to)211-217
Number of pages7
JournalAmerican Journal of Obstetrics and Gynecology
Volume183
Issue number1
DOIs
StatePublished - Jan 1 2000
Externally publishedYes

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Fetofetal Transfusion
Pregnancy
Umbilical Arteries
Cerebral Palsy
Gestational Age
Edema
Fetal Death
Pregnancy Outcome
Nervous System
Fetus
Parturition

All Science Journal Classification (ASJC) codes

  • Obstetrics and Gynecology

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Long-term outcome in twin-twin transfusion syndrome treated with serial aggressive amnioreduction. / Mari, Giancarlo; Detti, Laura; Oz, Utku; Abuhamad, Alfred Z.

In: American Journal of Obstetrics and Gynecology, Vol. 183, No. 1, 01.01.2000, p. 211-217.

Research output: Contribution to journalArticle

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abstract = "OBJECTIVE: The purpose of this study was to determine long-term outcomes among pregnancies complicated by twin-twin transfusion syndrome and treated in a tertiary center with serial aggressive amnioreduction. STUDY DESIGN: Thirty-three pregnancies with a diagnosis of twin-twin transfusion syndrome were treated with ≥1 amnioreduction. The perinatal outcome was assessed according to 15 parameters, whereas the main outcome at age ≥2 years was the absence of cerebral palsy. RESULTS: Gestational age at diagnosis ranged from 14.5 to 33 weeks’ gestation (median, 20.6 weeks’ gestation), whereas gestational age at delivery was between 18.5 and 37 weeks’ gestation (median, 30.5 weeks’ gestation). The number of amnioreductions per pregnancy ranged from 1 to 15 (median, 2). At initial examination hydrops of the recipient and absence of the end-diastolic velocity of the umbilical artery in one of the twins were associated with poor prognosis. Fifty-one (77{\%}) twins were born alive. At 24 months after birth both infants from 57{\%} of the pregnancies (19/33) were alive, whereas at least one infant from 70{\%} of the pregnancies (23/33) was alive. Thirty-three infants (78{\%} of the survivors) were older than 36 months at last follow-up. Cerebral palsy was diagnosed in 2 of 42 infants (4.7{\%}). One of the affected infants was born after the fetal death of the cotwin; the other infant was born with congenital cardiac malformations. CONCLUSIONS: In the group of fetuses in which both twins were delivered alive after 27 weeks' gestation without congenital malformations and survived the neonatal period, no major neurologic handicaps developed in any of the infants. At initial examination both hydrops of the recipient and absence of end-diastolic flow velocity waveforms of the umbilical artery in one of the twins were poor prognostic signs.",
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