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

Erin E. Washburn; Teresa N. Sparks; Kristen A. Gosnell; Larry Rand; Juan M. Gonzalez; Vickie A. Feldstein

doi:10.1055/s-0038-1627095

American Journal of Perinatology, Table of Contents

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

¹Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California

,

Teresa N. Sparks

¹Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California

,

Kristen A. Gosnell

²Fetal Treatment Center, University of California San Francisco, San Francisco, California

,

Larry Rand

¹Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California

²Fetal Treatment Center, University of California San Francisco, San Francisco, California

,

Juan M. Gonzalez

¹Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California

²Fetal Treatment Center, University of California San Francisco, San Francisco, California

,

Vickie A. Feldstein

²Fetal Treatment Center, University of California San Francisco, San Francisco, California

³Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California

› Author Affiliations

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

Full Text

References

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