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394: Outcome in triplets complicated by twin-twin transfusion syndrome (TTTS)

      Objective

      TTTS in high order multifetal pregnancy is a rare clinical event. Our aim is to describe the outcomes in triplets with TTTS compared to triplets without TTTS and twins with TTTS.

      Study Design

      A case control study of 17 triplets with TTTS from 2004-2008. Controls were defined as triplets without TTTS (n=55) in the same period or twins with TTTS (n=34) matched 1:2 by gestational age (GA) at presentation, stage and treatment. Variables included: treatment; GA at presentation, procedure and delivery; mode of delivery; birthweights of recipient (RT), donor (DO) and incipient (IP); and survival. Data were analyzed by Chi square, Fisher exact test or T- test.

      Results

      Among 390 multifetal pregnancies with TTTS, 17 (4.4%) triplets were identified. Distribution per Cincinnati staging system was stage I (n=1), II (n=2), III (n=2), IIIA (n=3), IIIB (n=3), IIIC (n=3), IV (n=2) and V (n=1). Three were managed expectantly. 14 underwent interventions: 7 amnioreduction (AR), 6 selective fetoscopic laser photocoagulation (SFLP) and one radiofrequency ablation (RFA). Overall fetal survival was 80% (41/51). Survival was 94% (16/17) bystander, 71% (12/17) recipient and 65% (11/17) donor. Two had pregnancy loss at <20 weeks and 13/17 (76.4%) delivered at <34 weeks. There was no statistical difference in survival comparing the triplets to the twins. Triplets with TTTS delivered at an earlier GA while bystander survival was similar to triplets without TTTS (Table).

      Conclusion

      Outcomes of triplets with TTTS are comparable to twins with TTTS and triplets without TTTS when staged and treated accordingly.
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