Poster Session 3
Category: Fetal Intervention
Poster Session 3
Raphael C. Sun, MD
Associate Professor
Oregon Health & Science University
Portland, Oregon, United States
Andrew H. Chon, MD
Oregon Health & Science University
Portland, Oregon, United States
Lisa M. Korst, MD, PhD
Childbirth Research Associates
North Hollywood, California, United States
Arlyn S. Llanes, MHA, RN
Keck School of Medicine of USC, University of Southern California
Keck School of Medicine of USC, University Of Southern California, California, United States
Martha A. Monson, MD (she/her/hers)
Assistant Professor
Intermountain Healthcare
Salt Lake City, Utah, United States
Ramen H. Chmait, MD (he/him/his)
Director, Los Angeles Fetal Surgery; Professor, Department of Obstetrics and Gynecology
Keck School of Medicine of USC, University of Southern California
Keck School of Medicine of USC, University Of Southern California, California, United States
Per Quintero TTTS staging, donor umbilical artery (UA) intermittent absent or reversed end diastolic flow (A/REDF) is classified as stage I or II depending on donor twin bladder status, whereas UA persistent A/REDF is classified as stage III. However, this distinction between intermittent and persistent UA-A/REDF has led to ambiguity between centers in regard to staging of TTTS. Here, we compared laser surgery outcomes in stage II patients with intermittent UA-A/REDF (Stage-II Intermittent) vs stage II patients with a normal UA waveform (Stage-II Normal), using stage III patients with persistent donor twin UA-A/REDF (Stage-III) for comparison.
Study Design:
Three groups of monochorionic diamniotic twins with TTTS treated with laser surgery (2006-2023) were analyzed: (1) Stage-II Normal; (2) Stage-II Intermittent; and (3) Stage-III. The groups were compared in bivariate analysis and in a multiple logistic regression model for the primary outcome of donor twin fetal demise (IUFD).
Results:
The 400 study patients were divided into Stage-II Normal (n=126), Stage-II Intermittent (n=62), and Stage-III (n=212). In bivariate analyses, the rates of donor IUFD were 7.1% vs 8.1% vs 29.2%, P< .0001, respectively. Dual survivorship was 84.1% vs 82.3% vs 62.7%, P< .0001, respectively. Multiple covariates were eligible for inclusion in the logistic regression model, including gestational age at the procedure, the preoperative estimated fetal weight of the donor, and the presence of arterioarterial anastomoses. Upon adjustment in a multiple logistic regression model, the Stage-II Intermittent group did not have an increased risk of donor IUFD vs Stage-II Normal (aOR 0.51, 95% CI 0.15–1.79).
Conclusion:
TTTS stage II patients with intermittent UA-A/REDF did not have increased risk of donor IUFD compared to stage II patients with normal UA Dopplers. These findings support the traditional Quintero staging classification, and only persistent UA-A/REDF should be classified as TTTS stage III.