Fetal brain-sparing after laser surgery for twin-twin transfusion syndrome appears associated with two-year neurodevelopmental outcomes

Prenat Diagn. 2016 Jan;36(1):63-7. doi: 10.1002/pd.4713. Epub 2015 Nov 22.


Objective: The cerebroplacental ratio (CPR) is a semi-quantitative marker for fetal brain-sparing. Our purpose was to measure the CPR at the time of treatment with selective laser photocoagulation of communicating vessels in gestations with twin-twin transfusion syndrome (TTTS) to test its association with neurological outcomes at approximately 2 years.

Methods: One-hundred children treated for TTTS with laser surgery underwent neurodevelopmental assessment at age 2 years (within 6 weeks) via the Battelle Developmental Inventory 2nd Edition (BDI-2). The CPR was obtained 24 h before and after laser surgery. An abnormal CPR was categorically defined at <1.0. Multilevel linear regression was used to evaluate associations between CPR and neurodevelopment as assessed by the BDI-2.

Results: Ninety-nine children had data available for analysis: 55 (56%) had normal CPR prior to laser surgery, and 62 (63%) had normal CPR following surgery. Post-laser CPR <1.0 was a risk factor for lower BDI-2 scores at age 2 years [98.1 (SD 11.5) vs 103.4 (SD 12.3) vs β = -0.23, p = 0.01]; this relationship remained significant after controlling for pre-surgical CPR and Quintero stage (adjusted β = -0.25, p = 0.01).

Conclusions: In this population, an abnormal CPR was associated with poorer 2-year neurodevelopmental outcomes. © 2015 John Wiley & Sons, Ltd.

MeSH terms

  • Brain / embryology*
  • Child, Preschool
  • Developmental Disabilities / diagnosis
  • Developmental Disabilities / etiology*
  • Female
  • Fetofetal Transfusion / complications
  • Fetofetal Transfusion / surgery*
  • Fetoscopy*
  • Follow-Up Studies
  • Humans
  • Laser Coagulation*
  • Linear Models
  • Male
  • Neuropsychological Tests
  • Placenta / embryology*
  • Pregnancy
  • Retrospective Studies
  • Risk Factors