Obstetric and perinatal outcomes from the australian and new zealand twin-twin transfusion syndrome registry

Am J Obstet Gynecol. 2000 Mar;182(3):706-12. doi: 10.1067/mob.2000.104236.


Objective: Our purpose was to investigate the antepartum characteristics and perinatal outcomes of twin-twin transfusion syndrome cases from a multicenter national registry.

Study design: Perinatal centers in Australia and New Zealand voluntarily notified a central evaluation registry with information on identified pregnancies with twin-twin transfusion syndrome during 1995 through 1998.

Results: One hundred twelve cases of twin-twin transfusion syndrome were registered. The median gestation at diagnosis was 21.5 weeks (range, 14.4-34.6 weeks). Oligohydramnios-polyhydramnios sequence was the most common presentation, with 84% of cases involving "stuck" twinning. Therapeutic amnioreduction was used in 92 cases (82.1%), with the median number of procedures per case being 2 (range, 1-23). The median gestation at delivery was 29 weeks (range, 18-38 weeks). The overall perinatal survival rate was 62.5%. Abnormal findings on cranial ultrasonography were present in 27.3% of live neonates, and periventricular leukomalacia was reported in 10.8%. Increased gestational age at delivery, the presence of umbilical artery diastolic flow, and a prolonged interval from final amnioreduction to delivery were positively associated with the delivery of live fetuses without complications.

Conclusion: The majority of antenatally identified cases of twin-twin transfusion syndrome are managed with serial amnioreduction. Despite contemporary obstetric and neonatal management strategies, perinatal mortality and morbidity rates are high.

MeSH terms

  • Australia
  • Blood Flow Velocity
  • Congenital Abnormalities / epidemiology
  • Female
  • Fetal Death
  • Fetofetal Transfusion / diagnostic imaging
  • Fetofetal Transfusion / epidemiology*
  • Fetofetal Transfusion / therapy
  • Gestational Age
  • Humans
  • Infant Mortality
  • Infant, Newborn
  • Leukomalacia, Periventricular / epidemiology
  • New Zealand
  • Obstetric Labor, Premature / epidemiology
  • Pregnancy
  • Pregnancy Outcome
  • Registries*
  • Ultrasonography
  • Umbilical Arteries / diagnostic imaging