Perinatal survival in cases of twin-twin transfusion syndrome complicated by selective intrauterine growth restriction

J Matern Fetal Neonatal Med. 2015 Sep;28(13):1549-53. doi: 10.3109/14767058.2014.960834. Epub 2014 Sep 29.


Objective: To evaluate the impact of selective intrauterine growth restriction (SIUGR) on monochorionic multiples treated with selective laser photocoagulation of communicating vessels (SLPCVs) for twin-twin transfusion syndrome (TTTS).

Methods: Perinatal survival was compared among TTTS patients with and without SIUGR. The TTTS + SIUGR group was defined as TTTS patients with donor twin weight <10th percentile. Multivariable logistic regression analyses identified factors associated with 30-day survival.

Results: Of 369 patients, 65% (N = 241) had TTTS + SIUGR. Thirty-day donor twin survival for the TTTS-only group was 84% versus 75% in the TTTS + SIUGR group (p = 0.0348). Stage III donor involved (stage III donor, donor/recipient) TTTS + SIUGR patients (N = 110) had 66% 30-day donor survival. Multivariable logistic regression demonstrated that the TTTS-only group was twice as likely to achieve donor survival compared to the TTTS + SIUGR group (OR 2.01, 95% CI 1.11-3.66, p = 0.0214). In the TTTS + SIUGR group, patients not classified as stage III donor-involved were twice as likely to achieve donor survival as stage III donor-involved patients (OR 2.02, 95% CI 1.10-3.71, p = 0.0226).

Conclusions: SIUGR, present in two-thirds of TTTS patients, was a risk factor for decreased donor survival. Patients with donor SIUGR and umbilical artery persistent or reversed end-diastolic flow (Quintero Stage III Donor-involved) were especially at risk.

Keywords: Fetal growth restriction; SIUGR; TTTS; fetoscopy; laser surgery; monochorionic.

MeSH terms

  • Adult
  • Female
  • Fetal Growth Retardation / mortality*
  • Fetal Growth Retardation / surgery
  • Fetofetal Transfusion / complications
  • Fetofetal Transfusion / mortality*
  • Fetofetal Transfusion / surgery
  • Fetoscopy / methods
  • Gestational Age
  • Humans
  • Infant, Newborn
  • Laser Coagulation / methods
  • Pregnancy
  • Pregnancy Outcome / epidemiology*
  • Pregnancy, Twin*
  • Survival Analysis
  • Twins, Monozygotic / statistics & numerical data
  • Umbilical Arteries / surgery
  • Young Adult