Poster Session 3
Manasa G. Rao, MD
Resident Physician
Columbia University Medical Center
New York, New York, United States
Christy Gandhi, MD (she/her/hers)
Columbia University Medical Center
New York, New York, United States
Noelle Breslin, MD
Columbia University Medical Center
New York, New York, United States
Meghan Angley, PhD
Postdoctoral Research Scientist
Columbia University Medical Center
New York, New York, United States
Rosalie Ingrassia, RN
Columbia University Medical Center
New York, New York, United States
Lynn L. Simpson, MD (she/her/hers)
Hillary Rodham Clinton Professor of Women's Health
Columbia University Irving Medical Center
New York, New York, United States
Russell S. Miller, MD (he/him/his)
Sloane Hospital for Women Associate Professor of Prenatal Pediatrics (in Obstetrics and Gynecology)
Columbia University Medical Center
New York, New York, United States
An optimal inter-twin discordance cutoff for predicting survival outcomes in monochrionic-diamniotic (MCDA) twin pregnancies is unclear. This study aimed to evaluate the association of inter-twin discordance with donor twin survival after fetosopic laser surgery (FLS) for twin-twin transfusion syndrome (TTTS), and to identify an optimal discordance cutoff.
Study Design:
Retrospective review of monochorionic diamniotic (MCDA) twins with TTTS that underwent FLS at a single center from 2009-22. Primary outcome was donor twin survival at first sonogram after FLS. Logistic regression models estimated association between inter-twin discordance and donor survival at different thresholds. Receiver operating characteristic (ROC) curve analysis was performed to assess predictive accuracy and Youden index was used to determine the optimum cut-point for predictive accuracy.
Results:
169 MCDA pregnancies met inclusion criteria. Discordance cutoffs of ≥25% and ≥30% were significantly associated with donor twin survival at first sonogram post-FLS (p=0.03 and p< 0.001, respectively) and this was true after adjusting for donor fetal growth restriction and Quintero stage pre-FLS. In fitting a logistic regression model, discordance as a continuous variable was significantly associated with predicting donor twin survival (p=0.02). The AUC for predicting donor twin survival was 0.63 (95% CI: 0.49, 0.74, p=0.060). Based on the Youden index, the optimum cut point is a discordance of 29%, which has a sensitivity of 0.75, specificity of 0.58, positive predictive value of 0.91 and negative predictive value of 0.29 in predicting donor twin survival.
Conclusion:
Inter-twin discordance is a poor predictor of donor twin survival after FLS for TTTS. If it is to be considered in clinical practice, a cutoff value of 29% was most predictive of donor twin survival in this cohort.
