Fetal echocardiographic findings are not predictive of death in twin-twin transfusion syndrome

Objective. The purpose of this study was to determine whether fetal echocardiographic findings are predictive of prognosis in recipient fetuses with twin-twin transfusion syndrome (TTTS). Methods. A cohort of 30 pregnancies with TTTS between 1990 and 2001 was included. Diagnosis and staging of TTTS were made according to the Quintero system. Fetal echocardiographic findings of cardiomegaly, right ventricular hypertrophy, and tricuspid regurgitation were evaluated for relationship with fetal death. Power analysis revealed an approximately 80% power to detect a 2-fold increased risk of fetal death, with alpha = .05. Logistic regression was used to determine the relationship between echocardiographic findings and death. Results. Most pregnancies were Quintero stage 1, n = 13 (43%), and ranged in severity to Quintero stage 5, n = 4 (13%). Cardiac findings in the recipient fetus that were assessed for a relationship with death included cardiomegaly at the initial appearance of TTTS or at the most severe evaluation findings, right ventricular hypertrophy at initial appearance or at the most severe evaluation findings, or tricuspid regurgitation at initial appearance or at the most severe evaluation findings. Fetal or neonatal death in the recipient twin was not related to the presence of cardiac findings (odds ratio, 0.77; 95% confidence interval, 0.16-3.74). Conclusions. Fetal echocardiographic findings, whether evaluated at initial appearance or over the course of serial evaluations, were not related to fetal or neonatal death in recipient twins with TTTS.