Ultrasound prognostic factors after laser surgery for twin-twin transfusion syndrome to predict survival at 6 months

Objective To evaluate the significance of ultrasound findings, detected one or two weeks after laser surgery for twin-twin transfusion syndrome, in predicting the mortality at 6 months of age. Methods Ultrasound evaluation including fetal biometry, amniotic fluid volume estimation and Doppler examination was performed between 7 and 14 days after surgery for 181 cases. The presence of one or more effusions and single fetal death were also determined. Associations between ultrasound findings and mortality at 6 months of age were evaluated using multiple logistic regression analysis. Results Of the total 181 pairs, 145 (80.1%) donor and 160 (88.1%) recipient twins survived in utero for more than 7 days after surgery, and hence were included in the analysis. The survival rate at 6 months was 66.9% for the donor and 80.7% for the recipient twins. Risk factors for death in the donor were the presence of severe intrauterine growth restriction and effusions. In recipients, elevation in the middle cerebral artery peak systolic velocity coincided with fetal death, but this occurred in only three cases. Conclusion Ultrasound risk factors one week after surgery included severe intrauterine growth restrictions and effusions in the donor twins. Copyright (C) 2011 John Wiley & Sons, Ltd.