Obstet Gynecol Sci.  2023 Nov;66(6):529-536. 10.5468/ogs.23108.

Fetal growth changes and prediction of selective fetal growth restriction following fetoscopic laser coagulation in twin-to-twin transfusion syndrome

• Kim SY
• Won HS
• Lee MY
• Chung JH
• Park JH
• Kim YK
• Lee HM

• KMID: 2547854
• DOI: http://doi.org/10.5468/ogs.23108

Abstract

Objective
To investigate fetal growth changes and predictive factors for selective fetal growth restriction (sFGR) in patients with twin-to-twin transfusion syndrome (TTTS) after fetoscopic laser coagulation (FLC).
Methods
This retrospective study included twin-pregnant women with fetal TTTS who underwent FLC at our institution between 2011 and 2020. Twin pairs who survived at least 28 days after FLC and at least 28 days after birth were included. A paired t-test was used to compare the mean discordance between the estimated fetal weights at the FLC and the birth weights. The predictive factors for sFGR after FLC were evaluated using univariate and multivariate logistic regression analyses.
Results
A total of 119 eligible pairs of patients who underwent FLC were analyzed. The weight percentile at birth significantly decreased after FLC in the recipients (53.7±30.4 percentile vs. 43.7±28.0 percentile; P<0.001), but increased in the donors (11.5±17.1 percentile vs. 20.7±22.8 percentile; P<0.001). Additionally, the mean weight discordance of twin pairs significantly decreased after FLC (23.9%±12.7% vs. 17.3%±15.7%; P<0.001). After FLC, Quintero stage ≥3, pre-FLC sFGR, abnormal cord insertion, and post-FLC abnormal umbilical artery Doppler (UAD) were all significantly higher in the sFGR group than the non-sFGR group. The prediction model using these variables indicated that the area under the receiver operating characteristic curve was 0.898.
Conclusion
The recipient weight percentile decreased, whereas donor growth increased, resulting in reduced weight discordance after FLC. The Quintero stage, pre-FLC sFGR, and post-FLC abnormal UAD were useful predictors of sFGR after FLC in TTTS.

Keyword

Fetal growth; Fetal growth restriction; Twin-to-twin transfusion syndrome; Fetoscopic surgery

Figure

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  Fig. 1 Flow chart of the study group. FLC, fetoscopic laser coagulation; TAPS, twin anemia polycythemia sequence; F/U, follow-up.

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  Fig. 2 Prediction model for selective fetal growth restriction in twin-to-twin transfusion following fetoscopic laser coagulation. ROC, receiver operating characteristic; AUC, area under the curve.

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