Preoperative prediction of the individualized risk of early fetal death after laser therapy in twin-to-twin transfusion syndrome.

Published on Nov 1, 2013in Prenatal Diagnosis3.05
· DOI :10.1002/PD.4191
Elisenda Eixarch30
Estimated H-index: 30
(University of Barcelona),
Dan V. Valsky26
Estimated H-index: 26
+ 5 AuthorsEduard Gratacós88
Estimated H-index: 88
(University of Barcelona)
Sources
Abstract
The aim of this study is to evaluate the independent and combined value of gestational age, fetal weight, fetoplacental Doppler, and myocardial performance index for the prediction of individual risk of early ( 1.5 MoM (OR = 22, p = 0.015), but this event was present in only 3% of recipients. In donors, reverse end diastolic flow in the umbilical artery (OR = 14.748, p = 0.033), estimated fetal weight discordance (OR = 1.054, p = 0.036), and gestational age (OR = 0.757, p = 0.046) were independent predictors.In TTTS, preoperative fetal assessment can identify independent risk factors for early post-operative IUFD, particularly in donors. © 2013 John Wiley& Sons, Ltd.
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References42
Newest
#1Julien Stirnemann (Paris V: Paris Descartes University)H-Index: 24
#2B. Nasr (Paris V: Paris Descartes University)H-Index: 4
Last. Yves Ville (Paris V: Paris Descartes University)H-Index: 84
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Objective Prognostic assessment in twin-to-twin transfusion syndrome (TTTS) is ill-defined. The objective of this study is to define a perioperative prognostic score for TTTS treated by percutaneous laser coagulation. Methods Consecutive cases of TTTS treated by percutaneous fetoscopic laser coagulation over a 6-year period were reviewed. Twin survival at 28 days was considered using a 3-level polytomous variable defined by 0, 1, or 2 fatal events. A multivariate prognostic analysis with interna...
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#1Mariangela RusticoH-Index: 20
#2Mariano LannaH-Index: 13
Last. Enrico FerrazziH-Index: 61
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Objective: To report the incidence of fetal and maternal complications after selective fetoscopic laser surgery for twin-to-twin transfusion syndrome (TTTS). Methods: A total of 150 cases of TTTS were treated from January 2004 to June 2009 (period 1, 2004–2006, 62 cases; period 2, 2007 to June 2009, 88 cases). Fetal complications (double and single intrauterine fetal death, recurrence of TTTS, twin anemia-polycythemia sequence (TAPS), reversal of TTTS, cerebral lesions in one twin) and maternal ...
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#1Ngoc-Tu TrieuH-Index: 1
#2A. S. WeingertnerH-Index: 10
Last. Romain FavreH-Index: 27
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Objective The aim of this study is to evaluate the incidence of elevated middle cerebral artery peak systolic velocity (MCA-PSV) in twin-to-twin transfusion syndrome (TTTS) before and after laser and its predictive value for intrauterine fetal death (IUFD) occurring within 2 to 7 days following laser. Method This is a 5-year retrospective single-center study on 86 consecutive laser procedures for TTTS. MCA-PSV was measured prior to and 48 h following laser. We correlated perioperative MCA-PSV an...
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#1Mina Itsukaichi (Niigata University)H-Index: 5
#2Akira KikuchiH-Index: 109
Last. Kenichi TanakaH-Index: 47
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Objective: Our aim was to investigate the association between fetal growth and cerebrovascular resistance in fetuses with congenital heart disease (CHD). Methods:
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#1Ahmet Baschat (UMB: University of Maryland, Baltimore)H-Index: 59
#2Ramen H. Chmait (SC: University of Southern California)H-Index: 25
Last. Yves Ville (University of Paris)H-Index: 84
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Twin-to-twin transfusion syndrome (TTTS) is a severe complication of monochorionic (MC) twin pregnancies, characterized by the development of unbalanced chronic blood transfer from one twin, defined as donor twin, to the other, defined as recipient, through placental anastomoses. If left untreated, TTTS is associated with very high perinatal mortality and morbidity rates, due to a combination of fetal and/or obstetric complications. The reported prevalence is 10―15% of all MC twins, or about 1 i...
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Objectives To evaluate the outcome and preoperative risks of twin–twin transfusion syndrome (TTTS) following fetoscopic laser surgery (FLS). Methods A retrospective cohort study of a series of 181 consecutive cases of TTTS before 26 weeks' gestation subjected to FLS at four centers in Japan between July 2002 and December 2006. Results The chances of survival of at least one twin at 28 days of age and 6 months of age were 91.2% and 90.1%, respectively. The rate of major neurological complications...
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#1Daniel W. Skupski (Cornell College)H-Index: 31
#2Francois I. Luks (Brown University)H-Index: 46
Last. Ozan M. Bahtiyar (Yale University)H-Index: 10
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Objective To determine preoperative predictive factors for donor and recipient death after laser ablation of placental vessels in twin-to-twin transfusion syndrome. Study Design Retrospective analysis of North American Fetal Therapy Network center laser procedures, 2002-2009. Factors associated with donor and recipient death were identified by regression analysis. Results There were 466 patients from 8 centers. Factors significantly associated with donor fetal death were low donor estimated feta...
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#1Julien Stirnemann (Paris V: Paris Descartes University)H-Index: 24
#2Mathilde Mougeot (Paris West University Nanterre La Défense)H-Index: 7
Last. Yves Ville (Paris V: Paris Descartes University)H-Index: 84
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Objectives Cardiomyopathy in the recipient twin is a marker of severity in twin–twin transfusion syndrome (TTTS), making it a potentially valuable tool for staging the disease. This study aimed to provide a quantitative description of cardiac function in the recipient twin. Methods Consecutive monochorionic pregnancies complicated with TTTS and treated by percutaneous laser coagulation underwent fetal echocardiography before surgery. An unsupervised classification analysis was conducted to ident...
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#1Christoph Berg (University of Bonn)H-Index: 33
#2Oliver Gembruch (University of Bonn)H-Index: 10
Last. A. Geipel (University of Bonn)H-Index: 17
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Objectives To assess changes in the Doppler flow profiles of the middle cerebral artery in fetuses with cardiac defects theoretically associated with impaired cerebral oxygen delivery in utero. Methods Z-scores were calculated for pulsatility and resistance indices (PI and RI, respectively) of the middle cerebral artery (MCA) and the cerebroplacental ratio (CPR) between 19 and 41 weeks' gestation, and for head circumference at birth (HC), in 113 fetuses with the following isolated cardiac defect...
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#1B. NasrH-Index: 2
#2Julien StirnemannH-Index: 24
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Cited By16
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#1Ariane C. Youssefzadeh (SC: University of Southern California)H-Index: 1
#2Gabrielle L. Glassen (SC: University of Southern California)H-Index: 1
Last. Ramen H. Chmait (SC: University of Southern California)H-Index: 25
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Objective null To evaluate all individual cases of dual twin demise following laser surgery for twin-twin transfusion syndrome (TTTS). null Method null This is an analysis of all monochorionic diamniotic twin gestations with TTTS complicated by dual demise following laser surgery from 2006 to 2019. Cases were reviewed by (1) a fetal surgeon researcher and (2) a panel of independent experienced maternal-fetal medicine specialists to code an etiology of demise for the donor and recipient, and to a...
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#1Ryo Yamamoto (Boston Children's Hospital)H-Index: 7
#2Airi Kuruma (Boston Children's Hospital)H-Index: 1
Last. Keisuke Ishii (Boston Children's Hospital)H-Index: 13
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OBJECTIVE To elucidate the significance of sonographic indices, including Doppler waveforms, that constitute the Quintero classification for predicting death of the recipient or donor after fetoscopic laser photocoagulation (FLP) for twin-twin transfusion syndrome (TTTS). METHODS Prospectively collected data of twins who underwent FLP for TTTS were reviewed. Among the abnormal indices of ultrasound performed just before FLP, factors that were significantly associated with fetal and neonatal deat...
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#1Rina Kim (UOU: University of Ulsan)H-Index: 1
#2Mi-Young Lee (UOU: University of Ulsan)H-Index: 13
Last. Hwa-Jung Kim (Asan Medical Center)
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OBJECTIVES This single-center study aimed to assess the perinatal outcomes and its associated factors in fetuses with twin-to-twin transfusion syndrome (TTTS) treated by fetoscopic laser coagulation (FLC). METHODS In this retrospective study, we included fetuses prenatally diagnosed with TTTS at Asan Medical Center, Seoul, Korea, between October 2011 and December 2018. All patients with TTTS stage II or higher and those with stage I TTTS coupled with symptomatic polyhydramnios or cardiac dysfunc...
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#1Margaret E. Purnell (SC: University of Southern California)H-Index: 1
#2Andrew H. Chon (SC: University of Southern California)H-Index: 7
Last. Ramen H. Chmait (SC: University of Southern California)H-Index: 25
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INTRODUCTION: To examine the association of preoperative absent end-diastolic velocity (AEDV) and percent AEDV (%AEDV) in the umbilical artery (UA) with donor twin intrauterine fetal demise (IUFD) after laser surgery for twin-twin transfusion syndrome (TTTS). METHODS: We performed a retrospective study of stage III/IV TTTS patients who underwent laser surgery from 2006 to 2016. Donors were classified as having preoperative persistent AEDV (yes/no). %AEDV was calculated for those with AEDV as 100...
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#1Manon Gijtenbeek (LUMC: Leiden University Medical Center)H-Index: 3
#2Sanne J. Eschbach (LUMC: Leiden University Medical Center)H-Index: 3
Last. Monique C. Haak (LUMC: Leiden University Medical Center)H-Index: 29
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: This study aimed to investigate the value of echocardiography and Doppler before fetoscopic laser coagulation for twin-twin transfusion syndrome (TTTS) in the prediction of intrauterine fetal demise (IUFD). We performed a systematic review and meta-analysis to compare preoperative parameters between fetuses with and without demise after laser surgery. Eighteen studies were included. Recipient twins have an increased risk of demise in case of preoperative absent/reversed flow (A/REDF) in the um...
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#1Matthew M. Finneran (OSU: Ohio State University)H-Index: 5
#2Megan Templin (Carolinas Healthcare System)H-Index: 6
Last. Courtney D. StephensonH-Index: 7
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AbstractObjective: To investigate the natural course of abnormal umbilical artery Doppler (UAD) findings in donor fetuses after laser surgery and the prognostic significance of resolution, persistence, or new onset UAD abnormalities with and without the presence of preoperative growth discordance.Study design: Retrospective cohort study of all monochorionic-diamniotic multi-fetal gestations diagnosed with twin-twin transfusion syndrome (TTTS) undergoing laser surgery at a single large metropolit...
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#1Helen Perry (St George's, University of London)H-Index: 11
#2James M.N. Duffy (University of Oxford)H-Index: 25
Last. Asma Khalil (St George's, University of London)H-Index: 56
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Objective Twin–twin transfusion syndrome (TTTS) is associated with significant mortality and morbidity. Potential treatments for the condition require robust evaluation. The aim of this study was to evaluate outcome reporting across observational studies and randomized controlled trials assessing treatments for TTTS. Methods Cochrane Central Register of Controlled Trials, EMBASE and MEDLINE were searched from inception to August 2016. Observational studies and randomized controlled trials report...
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#4Florent Fuchs (UdeM: Université de Montréal)H-Index: 11
OBJECTIVE: To determine the prognostic value of fetal Doppler and echocardiographic parameters for intrauterine fetal demise (IUFD) within 24 hours and within 1 week after laser coagulation in monochorionic pregnancies complicated by twin-twin transfusion syndrome. METHOD: This retrospective study correlated the preoperative hemodynamic and echocardiography parameters to the outcome in fetuses with twin-twin transfusion syndrome undergoing laser therapy. RESULTS: One hundred and twelve laser coa...
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#1Susumu Murata (Kawasaki Medical School)H-Index: 8
#2Mayumi Takano (Toho University)H-Index: 6
Last. Masahiko Nakata (Toho University)H-Index: 20
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AbstractObjective: Fetoscopic laser photocoagulation of vascular anastomoses (FLP) is the essential choice in twin-twin transfusion syndrome (TTTS). We proposed that the modified sequential selective laser photocoagulation of communicating vessels (modified SQLPCV) to clarify the perinatal outcomes in TTTS.Methods: The modified SQLPCV was designed with the following order: 1, artery-to-artery anastomoses; 2, venous-to-venous anastomoses; 3, artery-to-venous anastomoses from donor to recipient; a...
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AbstractObjective: To validate the efficacy of laser therapy for twin–twin transfusion syndrome (TTTS) in the treatment of recipient twin cardiomyopathy and investigate whether severity of preoperative cardiomyopathy can predict fetal survival postoperatively.Study design: Retrospective study of monochorionic-diamniotic (MCDA) pregnancies complicated by TTTS treated by selective fetoscopic laser photocoagulation (SFLP) performed between March 2010 and October 2014 at a single center. The recipie...
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