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
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
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
Noelle Breslin, MD
Columbia University Medical Center
New York, New York, United States
Inter-twin growth discordance is associated with adverse pregnancy outcomes in monochrionic-diamniotic (MCDA) twin pregnancies with ≥25% considered a cutoff for pathological discordance. We compared outcomes of fetoscopic laser surgery (FLS) for twin-twin transfusion syndrome based on presence of absence of discordance ≥25%.
Study Design: Retrospective review of MCDA twins with TTTS that underwent FLS at a single center from 2009-22. Pregnancies with pre-operative inter-twin discordance ≥25% were compared to those < 25%. Primary outcome was donor twin survival at first sonogram after FLS.
Results:
169 MCDA pregnancies underwent FLS and met inclusion criteria. 62 (37%) had discordance ≥25%. Patients with discordance ≥25% were younger (32 ± 5 vs 30 ± 6). GA at TTTS diagnosis and at FLS were similar between groups. Donor twin selective fetal growth restriction (sFGR) was more likely with discordance ≥25% (74.2% vs 23.4%, p< 0.01). Pre-FLS Quintero stage differed between the two groups (p=0.014), with higher likelihood of stage III and IV in the ≥25% group. Donor twin survival was significantly lower with discordance ≥25% at first post-FLS sonogram (75.8% vs 89.7%, p=0.02) and at hospital discharge (52.8% vs 73.6%, p=0.04). After adjusting for age, Quintero stage, and donor FGR, donor twin survival at first sonogram remained lower in patients with discordance ≥25% (p=0.01). In a subgroup analysis to evaluate discordance in pregnancies with donor sFGR, donor twin survival did not differ at first sonogram post-FLS (78.3% vs 96.0%, p=0.08) or at hospital discharge (61.5% vs 73.9%, p=0.3) between the groups. In a subgroup analysis of normally-grown twins, donor twin survival did not differ at first sonogram post-FLS (68.8% vs 87.7%, p=0.1) but was lower in the ≥25% discordance group at hospital discharge (80.33% vs 45.45%, p=0.02).
Conclusion:
Discordance ≥25% was associated with lower donor twin survival after FLS. While some effect may be attributable to co-existing donor FGR, discordance was associated with survival difference in normally-grown donor twins.
