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190: Risk of donor demise after laser therapy for twin-twin transfusion when complicated by growth restriction and abnormal umbilical artery Doppler

      Objective

      Donor twin abnormal umbilical artery (UA) Doppler and growth restriction are common ultrasonographic findings in twin-twin transfusion syndrome (TTTS) and indicate fetal compromise. This study aims to investigate the natural course of these findings after laser surgery for TTTS and the prognostic ability of either resolution or persistence of abnormal UA Doppler with and without intrauterine growth restriction (IUGR) to predict fetal demise.

      Study Design

      A retrospective cohort study of all monochorionic-diamniotic multi-fetal gestations diagnosed with TTTS undergoing laser surgery at a single large metropolitan referral center from 2010-2016. The estimated fetal weight was measured preoperatively and the UA Doppler was measured both pre- and postoperatively. Odds ratios were calculated for each group for risk of intrauterine fetal demise compared to the preoperative normal UA Doppler group. Post-operative odds ratios were calculated with an intent to treat analysis including patients with a donor demise prior to the postoperative ultrasound.

      Results

      There were 83 women who met inclusion criteria and 81 had delivery data available for analysis. Forty-three (51.8%) patients had abnormal donor twin UA Doppler preoperatively and thirty-three (39.8%) were diagnosed with IUGR. However, thirteen (30.2%) had normalization of the UA Doppler postoperatively (median=8 days). Abnormal preoperative UA Doppler was associated with an increased risk of donor demise (OR: 1.91; 0.50-7.29), which was further elevated in the presence of IUGR (OR: 6.3; 1.93-20.62). If the UA Doppler remained abnormal postoperatively, the risk of donor demise further increased (OR: 4.44; 1.02-19.38) and was highest if IUGR was also present preoperatively (OR: 16.0; 4.21-60.86).

      Conclusion

      Laser treatment for TTTS can lead to rapid resolution of abnormal UA Doppler post-operatively. However, persistence of abnormal UA Doppler findings, especially in the presence of IUGR, is a significant risk factor for donor intrauterine demise.
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