Perinatal morbidity and mortality rates in severe twin-twin transfusion syndrome

Results of the international amnioreduction registry

Giancarlo Mari, Alistair Roberts, Laura Detti, Ertug Kovanci, Theodor Stefos, Ray O. Bahado-Singh, Russell L. Deter, Nicholas M. Fisk

Research output: Contribution to journalArticle

167 Citations (Scopus)

Abstract

OBJECTIVE: Serial aggressive amnioreduction is the most widely used therapy for pregnancies that are complicated by twin-twin transfusion syndrome. Survival rates reported with this therapy are 33% to 83%, the wide range attributable to the small number of patients in these case series. Similarly, data on morbidity in survivors are imprecise. We instituted the international twin-twin transfusion syndrome registry to determine the perinatal survival and morbidity rates and the factors that influence perinatal outcome in patients with twin-twin transfusion syndrome who were treated with serial aggressive amnioreduction from 1990 to 1998. STUDY DESIGN: A total of 223 sets of twins who were diagnosed with twin-twin transfusion syndrome before 28 weeks' gestation from 20 fetal medicine referral centers were analyzed, with follow-up data until 4 weeks after birth. RESULTS: Three hundred forty-six twins (78%; 182 recipients and 164 donors) were born alive. Two hundred sixty-six twins (60%; 144 recipients and 122 donors) were alive 4 weeks after birth. Both fetuses survived to 4 weeks in 108 pregnancies (48.4%), whereas, at least 1 fetus survived in 158 pregnancies (70.8%). The interval between the last amnioreduction and delivery ranged from zero to 138 days (median, 17.5 days). In the infants who survived to 4 weeks after birth, abnormalities on neonatal cranial scan were diagnosed in 24% of recipients and in 25% of donors. Logistic regression analysis indicated that the survival rate was significantly related to gestational age at diagnosis, presence of end-diastolic blood flow in the umbilical artery velocity waveforms, presence of hydrops, mean volume of amniotic fluid removed per week, larger birth weight, and gestational age at delivery. The hemoglobin level difference at birth was the only significant parameter to predict abnormal cranial ultrasonography in newborns. CONCLUSION: These data document perinatal survival and neonatal morbidity rates in severe twin-twin transfusion syndrome that were treated by serial aggressive amnioreduction. Outcome was influenced by several perinatal risk factors, which may be used to counsel patients before and during therapy.

Original languageEnglish (US)
Pages (from-to)708-715
Number of pages8
JournalAmerican Journal of Obstetrics and Gynecology
Volume185
Issue number3
DOIs
StatePublished - Jan 1 2001
Externally publishedYes

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Fetofetal Transfusion
Perinatal Mortality
Registries
Morbidity
Mortality
Parturition
Pregnancy
Survival Rate
Tissue Donors
Gestational Age
Fetus
Umbilical Arteries
Amniotic Fluid
Birth Weight
Survivors
Ultrasonography
Edema
Hemoglobins
Therapeutics
Referral and Consultation

All Science Journal Classification (ASJC) codes

  • Obstetrics and Gynecology

Cite this

Perinatal morbidity and mortality rates in severe twin-twin transfusion syndrome : Results of the international amnioreduction registry. / Mari, Giancarlo; Roberts, Alistair; Detti, Laura; Kovanci, Ertug; Stefos, Theodor; Bahado-Singh, Ray O.; Deter, Russell L.; Fisk, Nicholas M.

In: American Journal of Obstetrics and Gynecology, Vol. 185, No. 3, 01.01.2001, p. 708-715.

Research output: Contribution to journalArticle

Mari, Giancarlo ; Roberts, Alistair ; Detti, Laura ; Kovanci, Ertug ; Stefos, Theodor ; Bahado-Singh, Ray O. ; Deter, Russell L. ; Fisk, Nicholas M. / Perinatal morbidity and mortality rates in severe twin-twin transfusion syndrome : Results of the international amnioreduction registry. In: American Journal of Obstetrics and Gynecology. 2001 ; Vol. 185, No. 3. pp. 708-715.
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abstract = "OBJECTIVE: Serial aggressive amnioreduction is the most widely used therapy for pregnancies that are complicated by twin-twin transfusion syndrome. Survival rates reported with this therapy are 33{\%} to 83{\%}, the wide range attributable to the small number of patients in these case series. Similarly, data on morbidity in survivors are imprecise. We instituted the international twin-twin transfusion syndrome registry to determine the perinatal survival and morbidity rates and the factors that influence perinatal outcome in patients with twin-twin transfusion syndrome who were treated with serial aggressive amnioreduction from 1990 to 1998. STUDY DESIGN: A total of 223 sets of twins who were diagnosed with twin-twin transfusion syndrome before 28 weeks' gestation from 20 fetal medicine referral centers were analyzed, with follow-up data until 4 weeks after birth. RESULTS: Three hundred forty-six twins (78{\%}; 182 recipients and 164 donors) were born alive. Two hundred sixty-six twins (60{\%}; 144 recipients and 122 donors) were alive 4 weeks after birth. Both fetuses survived to 4 weeks in 108 pregnancies (48.4{\%}), whereas, at least 1 fetus survived in 158 pregnancies (70.8{\%}). The interval between the last amnioreduction and delivery ranged from zero to 138 days (median, 17.5 days). In the infants who survived to 4 weeks after birth, abnormalities on neonatal cranial scan were diagnosed in 24{\%} of recipients and in 25{\%} of donors. Logistic regression analysis indicated that the survival rate was significantly related to gestational age at diagnosis, presence of end-diastolic blood flow in the umbilical artery velocity waveforms, presence of hydrops, mean volume of amniotic fluid removed per week, larger birth weight, and gestational age at delivery. The hemoglobin level difference at birth was the only significant parameter to predict abnormal cranial ultrasonography in newborns. CONCLUSION: These data document perinatal survival and neonatal morbidity rates in severe twin-twin transfusion syndrome that were treated by serial aggressive amnioreduction. Outcome was influenced by several perinatal risk factors, which may be used to counsel patients before and during therapy.",
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AU - Kovanci, Ertug

AU - Stefos, Theodor

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AU - Deter, Russell L.

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