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Am J Perinatol 2018; 35(14): 1352-1357
DOI: 10.1055/s-0038-1627095
SMFM Fellowship Series Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Stage I Twin–Twin Transfusion Syndrome: Outcomes of Expectant Management and Prognostic Features

Erin E. Washburn
1   Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California
,
Teresa N. Sparks
1   Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California
,
Kristen A. Gosnell
2   Fetal Treatment Center, University of California San Francisco, San Francisco, California
,
Larry Rand
1   Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California
2   Fetal Treatment Center, University of California San Francisco, San Francisco, California
,
Juan M. Gonzalez
1   Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California
2   Fetal Treatment Center, University of California San Francisco, San Francisco, California
,
Vickie A. Feldstein
2   Fetal Treatment Center, University of California San Francisco, San Francisco, California
3   Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
› Author Affiliations Funding Dr. Sparks was supported by grant 5K12HD001262–18 from the National Institutes of Health (NIH). The contents of the publication are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.
Further Information

Publication History

21 July 2017

29 December 2017

Publication Date:
08 February 2018 (online)

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Abstract

Objective This article describes the natural history of stage I twin–twin transfusion syndrome (TTTS) including risk of progression to higher stage TTTS and pregnancy outcomes, and to identify risk factors for progression.

Study Design Retrospective cohort study of monochorionic diamniotic (MCDA) twin pregnancies from 2006 to 2016 with expectantly managed Quintero stage I TTTS.

Results A total of 30 MCDA twin pregnancies with expectantly managed stage I TTTS were identified. Of these, eight (26.7%) progressed to higher stage TTTS. Median gestational age (GA) at diagnosis for those that progressed was 18.9 ± 2.9 weeks versus 21.4 ± 3.4 weeks in those that remained stable (p = 0.06). Presence of an arterioarterial (A-A) anastomosis was assessed for 20/30 patients, and eight A-A were identified. Of those, 7/8 (87.5%) remained stable. In the complete cohort, a tiny or transiently visible bladder was noted in seven donor twins. Of these, 4/7 (57.1%) progressed. Excluding one termination, 47/58 (81.0%) fetuses survived.

Conclusion With expectant management of stage I TTTS, nearly three-fourths of pregnancies remain stable and most have survival of ≥ 1 twin. A-A anastomoses were not associated with progression to higher stage TTTS, whereas earlier GA at diagnosis or a small or intermittently visible donor bladder may herald greater risk of progression.

Keywords

twin–twin transfusion syndrome - arterioarterial anastomosis - natural history - expectant management - Quintero stage I

Note

This study was presented in poster format at the 37th Annual Pregnancy Meeting of the Society for Maternal Fetal Medicine in Las Vegas, NV on January 23–27, 2017.


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