Doppler for artery-artery anastomosis and stage-independent survival in twin-twin transfusion

Tan, Tony Y. T., Taylor, Myles J. O., Wee, Ling Y., Vanderheyden, Tina, Wimalasundera, Ruwan and Fisk, Nicholas M. (2004) Doppler for artery-artery anastomosis and stage-independent survival in twin-twin transfusion. Obstetrics and Gynecology, 103 6: 1174-1180. doi:10.1097/01.AOG.0000127881.34144.d8

Author Tan, Tony Y. T.
Taylor, Myles J. O.
Wee, Ling Y.
Vanderheyden, Tina
Wimalasundera, Ruwan
Fisk, Nicholas M.
Title Doppler for artery-artery anastomosis and stage-independent survival in twin-twin transfusion
Journal name Obstetrics and Gynecology   Check publisher's open access policy
ISSN 0029-7844
Publication date 2004-01-01
Year available 2004
Sub-type Article (original research)
DOI 10.1097/01.AOG.0000127881.34144.d8
Open Access Status
Volume 103
Issue 6
Start page 1174
End page 1180
Total pages 7
Editor James R. Scott
Place of publication Philadelphia, PA, United States
Publisher Lippincott Williams & Wilkins
Language eng
Subject 111402 Obstetrics and Gynaecology
1114 Paediatrics and Reproductive Medicine
Formatted abstract
Objective: Treatment selection in twin–twin transfusion syndrome is increasingly determined by disease severity. We investigated whether detection of arterio-arterial anastomoses predicts perinatal survival.

Methods: An artery–artery anastomosis was sought by Doppler and disease stage was determined in 105 cases of twin–twin transfusion syndrome at presentation, first treatment, and worst stage. Outcome measures were perinatal, double, and any (1 or more babies) survival rates.

Results: After exclusion of 10 noninformative pregnancies, perinatal, double, and any survival rates were 61%, 44%, and 77%, respectively. When an anastomosis was detected at each of the 3 time points, perinatal and double survival rates were higher than when one was not (at first treatment, perinatal survival 83% versus 53%, respectively, P = .003; double survival 78% versus 33%, P < .001). Perinatal and double survival (P <= .01) were poorer with more advanced stage, but any survival rates were not influenced by stage or anastomosis detection. Multiple logistic regression demonstrated that anastomosis detection at treatment increased the chance of perinatal (odds ratio [OR] 5.1, 95% confidence interval [CI] 1.6, 15.9) and double survival (OR 19.3, 95% CI 2.7, 138), independently of stage. For stages I–III at treatment, anastomosis detection predicted better perinatal (100% versus 63%, 100% versus 59%, and 83% versus 44%, respectively) and double survival rates (100% versus 52%, 100% versus 46%, and 78% versus 26%). Stage III, with anastomoses detected, had better perinatal (83% versus 63%) and double survival (78% versus 52%) than did stage I without detection.

Conclusion: Antenatal detection of artery-to-artery anastomosis predicts higher perinatal and double survival in twin–twin transfusion syndrome, independently of disease stage.

Keyword Twin–twin transfusion syndrome
Monochorionic multiple pregnancy
Artery–artery anastomosis
Doppler detection
Q-Index Code C1
Institutional Status Non-UQ

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: Fri, 20 Mar 2009, 01:58:03 EST by Maria Campbell on behalf of Faculty Of Health Sciences