Stage I twin-twin transfusion syndrome: Rates of progression and regression in relation to outcome

O'Donoghue, K., Cartwright, E., Galea, P. and Fisk, N. M. (2007) Stage I twin-twin transfusion syndrome: Rates of progression and regression in relation to outcome. Ultrasound in Obstetrics and Gynecology, 30 7: 958-964. doi:10.1002/uog.5189

Author O'Donoghue, K.
Cartwright, E.
Galea, P.
Fisk, N. M.
Title Stage I twin-twin transfusion syndrome: Rates of progression and regression in relation to outcome
Journal name Ultrasound in Obstetrics and Gynecology   Check publisher's open access policy
ISSN 0960-7692
Publication date 2007-12
Year available 2007
Sub-type Article (original research)
DOI 10.1002/uog.5189
Volume 30
Issue 7
Start page 958
End page 964
Total pages 7
Editor Yves Ville
Place of publication Carnforth, U.K.
Publisher Parthenon
Language eng
Subject 111402 Obstetrics and Gynaecology
1114 Paediatrics and Reproductive Medicine
Formatted abstract
Objectives: Twin-twin transfusion syndrome (TTTS) results in high rates of perinatal mortality and neurological morbidity. Fetoscopic laser ablation of placental anastomoses is now established as the treatment of choice for advanced disease. However, there remains controversy about its use in early-stage TTTS, in which laser-related fetal losses need to be balanced against relatively favorable outcomes with more conservative approaches. We investigated rates of progression and regression in Stage I TTTS and determined factors influencing the course of the disease.
Methods: We undertook a retrospective observational study of all TTTS cases referred to our tertiary referral fetal medicine service from 2000 to 2006. In patients presenting with Stage I TTTS, the following variables were evaluated for their ability to predict the course and progression of the disease: gestational age (GA) at presentation, amniotic fluid index, recipient and donor deepest vertical pool, presence of artery-artery anastomoses, small-sized bladder compared to normal donor bladder and fetal size discordance. Study end-points were disease regression or progression, and neonatal survival at 28 days.
Results: Among 132 consecutive cases of TTTS, 46 women presented with Stage I disease. In the majority (69.6%), disease remained stable (28.3%) or regressed (41.3%). Of cases that progressed, 79% did so within 2 weeks and 93% progressed to at least Stage III. No factor was significantly linked with progression or regression, although there was a trend towards the absence of an artery-artery anastomosis (P = 0.10) and the presence of a small rather than normal donor bladder (P = 0.10) influencing progression, and later GA at presentation (P = 0.07) influencing regression. At least one infant survived in 83% of cases and there was double survival in 59%. Perinatal outcome was significantly better in cases that regressed (the rates of at least one survivor and double survival being 89% and 89%, respectively) or remained Stage I (77% and 61%, respectively), compared with those cases that progressed (79% and 14%, respectively). Treatment with amnioreduction at first presentation did not influence progression or regression.
Conclusions: This study demonstrates that a high percentage of Stage I TTTS cases regress or remain early stage. Identification of factors predicting progression would facilitate the selection of patients for definitive therapy, while avoiding treatment-related morbidities in mild or transient disease.
Copyright © 2010 ISUOG. Published by John Wiley & Sons, Ltd.

Keyword Monochorionic
Perinatal outcome
Stage I
Twin-twin transfusion syndrome
Q-Index Code C1

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
School of Medicine Publications
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Created: Mon, 23 Mar 2009, 11:08:28 EST by Mary-Anne Marrington on behalf of Faculty Of Health Sciences