Faculty Collaboration Database

North American Fetal Therapy Network: Timing of and indications for delivery following laser ablation for twin-twin transfusion syndrome. Am J Obstet Gynecol MFM 2019 Mar;1(1):74-81

Date

03/01/2019

Pubmed ID

32832884

Pubmed Central ID

PMC7437963

DOI

10.1016/j.ajogmf.2019.02.001

Scopus ID

2-s2.0-85078506524 (requires institutional sign-in at Scopus site)   12 Citations

Abstract

BACKGROUND: Despite improvements in fetal survival for pregnancies affected by twin-twin transfusion syndrome since the introduction of laser photocoagulation, prematurity remains a major source of neonatal morbidity and mortality.

OBJECTIVE: To investigate the indications and factors influencing the timing of delivery following laser treatment, we collected delivery information regarding twin-twin transfusion syndrome cases in a large multicenter cohort.

STUDY DESIGN: Eleven North American Fetal Therapy Network (NAFTNet) centers conducted a retrospective review of twin-twin transfusion syndrome patients who underwent laser photocoagulation. Clinical, demographic and ultrasound variables including twin-twin transfusion syndrome stage, and gestational age at treatment and delivery were recorded. Primary and secondary maternal and fetal indications for delivery were identified. Univariate analysis was used to select candidate variables with significant correlation with latency and GA at delivery. Multivariable Cox regression with competing risk analysis was utilized to determine the independent associations.

RESULTS: A total of 847 pregnancies were analyzed. After laser, the average latency to delivery was 10.11 ± 4.8 weeks and the mean gestational age at delivery was 30.7 ± 4.5 weeks. Primary maternal indications for delivery comprised 79% of cases. The leading indications included spontaneous labor (46.8%), premature rupture of membranes (17.1%), and placental abruption (8.4%). Primary fetal indications accounted for 21% of cases and the most frequent indications included donor non-reassuring status (20.5%), abnormal donor Dopplers (15.1%), and donor growth restriction (14.5%). The most common secondary indications for delivery were premature rupture of membranes, spontaneous labor and donor growth restriction. Multivariate modeling found gestational age at diagnosis, stage, history of prior amnioreduction, cerclage, interwin membrane disruption, procedure complications and chorioamniotic membrane separation as predictors for both gestational age at delivery and latency.

CONCLUSION: Premature delivery after laser therapy for twin-twin transfusion syndrome is primarily due to spontaneous labor, preterm premature rupture of membranes and non-reassuring status of the donor fetus. Placental abruption was found to be a frequent complication resulting in early delivery. Future research should be directed toward the goal of prolonging gestation after laser photocoagulation to further reduce morbidity and mortality associated with twin-twin transfusion syndrome.

Author List

Zaretsky MV, Tong S, Lagueux M, Lim FY, Khalek N, Emery SP, Davis S, Moon-Grady AJ, Drennan K, Treadwell MC, Petersen E, Santiago-Munoz P, Brown R, North American Fetal Therapy Network

Author

Erika Peterson MD Professor in the Obstetrics and Gynecology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Female
Fetal Therapies
Fetofetal Transfusion
Fetoscopy
Humans
Infant, Newborn
Laser Therapy
Placenta
Pregnancy
Retrospective Studies
United States