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224: Perinatal outcomes of twin twin transfusion syndrome based on gestational age at time of selective fetoscopic laser photocoagulation

      Objective

      Selective fetoscopic laser photocoagulation (SFLP) remains the treatment of choice for twin twin transfusion syndrome (TTTS). Little is known about perinatal outcomes after SFLP treatment for TTTS when stratified by gestational age (GA) at the time of SFLP treatment. Our objective is to describe gestational-age-at-treatment specific perinatal outcomes after SFLP treatment for TTTS.

      Study Design

      Data on all consecutive pregnancies diagnosed with TTTS (n=640) and treated by SFLP between 2008-2014 were reviewed. Exclusion criteria included fetal malformations, known chromosomal anomalies, and triplet gestations. Patient demographics and perinatal outcome data were collected. Data was stratified and compared based on GA at time of SFLP. ANOVA, T-test, and Chi-square tests were used as indicated.

      Results

      The average GA at the time of evaluation, SFLP, and delivery was 20.42 ± 2.53, 20.9±2.6, and 30.1±4.2 weeks, respectively. 63% (n=403/640) were Quintero Stage III TTTS and 37% (n=238) had selective IUGR. Overall survival was 91% (n=582) with 76% (n=485) donor survival and 88% (n=560) recipient survival. The rate of preterm delivery <28 weeks and <34 weeks were 26% (n=169) and 83% (n=529), respectively. There was no significant difference in Quinetro stage among groups (table). With increasing GA at SFLP, there was a significant increase in donor and recipient survival, gestational age at delivery, and a significant decrease in rate of pregnancy loss, preterm delivery <28 weeks, and double and single fetal demise in TTTS treated with SFLP.

      Conclusion

      Regardless of Quintero stage, earlier GA at the time of SFLP in TTTS is associated with higher rate of adverse pregnancy outcome and lower survival. This information is important in patient counseling. Further studies are needed to identify predictors of outcome.
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