(904) Twin Twin Transfusion Syndrome (TTTS) Stage 1: Do We Manage Expectantly vs. Treat Immediately?

Friday, January 31, 2025

10:30 AM – 12:30 PM

Submitting Author and Presenting Author(s)

Sami Backley, MD

Clinical Fellow PGY 9
Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States

Coauthor(s)

Eric P. Bergh, MD

Associate Professor
Nemours Children's Health
Wilmington, Delaware, United States
Jimmy Espinoza, MD, MSc

Professor
Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Felicia V. LeMoine, MD (she/her/hers)

Fetal Intervention Fellow
Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Neha Agarwal, MBBS, MD

Post doctoral Research Fellow
Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, UTHealth McGovern Medical School, Houston, TX, USA
Houston, Texas, United States
GV

Gustavo Vilchez, MD, MSCR

UTHealth Houston
Houston, Texas, United States
Percy N. Pacora-Portella, MD, MPH (he/him/his)

Associate Professor
Division of Fetal Intervention, Dpt Obstetrics,Gynecol and Reprod Sciences, McGovern Medical School at UTHealth Houston
Houston, TX, United States
Anthony Johnson, DO

Professor
McGovern Medical School University of Texas Health Science Center at Houston (UThealth)
Houston, Texas, United States
Edgar A. Hernandez-Andrade, MD, PhD (he/him/his)

Professor
McGovern Medical School at UTHealth Houston
Houston, Texas, United States
AS

Ashley Salazar, DNP

Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UT Health Houston
Houston, Texas, United States
SZ

Sen Zhu, PhD

McGovern Medical School at the University of Texas
Houston, Texas, United States
Ramesha Papanna, MD, MPH

Professor
McGovern Medical School at UTHealth Houston
Houston, Texas, United States

Objective: Randomized controlled trial (RCT) for twin-twin transfusion syndrome (TTTS) Stage 1 showed no difference in survival between expectant management and immediate fetoscopic laser surgery (FLS). However, higher perinatal survival with immediate FLS for TTTS Stage 1 has been reported and may justify immediate treatment. We aimed 1) to compare perinatal survival between expectant management and immediate treatment in TTTS Stage 1 and 2) to compare perinatal survival across TTTS Stages 1-4 who underwent FLS for treatment of TTTS.

Study Design: Perinatal survival of TTTS Stage 1 undergoing expectant management reported by Stirnemann et al, were compared to perinatal survival rates at our center utilizing prospective data from 90 monochorionic, diamniotic twin pregnancies complicated by TTTS Stage 1. All pregnancies underwent immediate FLS between 2011-2024. Pregnancies with cervical length < 1.5cm, non-isolated TTTS, missing delivery or neonatal outcomes were excluded. The primary outcome was dual perinatal survival. Survival outcomes for TTTS Stage 1 were also compared to TTTS stages 2-4.

Results: Our center's dual survival to birth was higher than the previously reported rates with expectant management of TTTS Stage 1 (Table 1). There was no difference in dual perinatal survival between our center and the previously reported rates in expectantly managed TTTS Stage 1 (Table 1); however, the sample size was not sufficient to detect the 10% difference in dual perinatal survival. Perinatal survival was higher in TTTS Stage 1 with immediate FLS when compared to other TTTS stages with FLS (Table 2).

Conclusion: Perinatal outcomes following immediate FLS for TTTS Stage 1 are more favorable when compared to other TTTS Stages and similar, or better, than expectant management. Immediate FLS should be considered a viable treatment option for TTTS stage 1, though a larger randomized trial to test the efficacy of immediate FLS should be considered.