Twin-Twin Transfusion Syndrome with and without Selective Fetal Growth Restriction: Predictors of Donor Demise.

OBJECTIVE Evaluate survival in Twin-Twin Transfusion Syndrome (TTTS) with and without Selective Fetal Growth Restriction (sFGR) after fetoscopic laser coagulation (FLS). METHODS Retrospective study of monochorionic diamniotic twins undergoing FLS. The cohort was classified as TTTS and TTTS with sFGR. Baseline, intra-operative and postoperative variables were analyzed. Mann-Whitney U, Pearson chi-square, Fisher's exact, T-test and receiver operating characteristic curve analysis were performed. RESULTS Four hundred and ninety-two pregnancies were included, 304 (61.78%) TTTS and 188 (38.22%) TTTS with sFGR. No difference in donor outcomes. TTTS group had higher donor estimated fetal weight (EFW%) percentile (19.7 ± 18.8 vs 2.2 ± 2.1, p 25% and intertwin umbilical artery pulsatility index discordance (DUAPI) ≥0.4 (AUC=0.71, p=0.001). CONCLUSION Combination of IWD of 37% and donor EFW% < 1st was most predictive for demise 30 days after birth. DUAPI ≥0.4 was also associated with increased risk for demise. This article is protected by copyright. All rights reserved.