Umbilical cord occlusion of the donor versus recipient fetus in twin–twin transfusion syndrome

• Published in: Ultrasound in obstetrics & gynecology Vol. 23; no. 5; pp. 446 - 450
• Main Authors: Nakata, M., Chmait, R. H., Quintero, R. A.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01-05-2004; Wiley
• Subjects: Biological and medical sciences; Chi-Square Distribution; Constriction; Female; Fetal Death; Fetofetal Transfusion - diagnostic imaging; Fetofetal Transfusion - surgery; fetoscopy; Gestational Age; Gynecology. Andrology. Obstetrics; Humans; Light Coagulation; Medical sciences; Obstetric Labor, Premature; Pregnancy; Pregnancy Reduction, Multifetal - methods; Statistics, Nonparametric; Twins; twin–twin transfusion syndrome; Ultrasonography, Prenatal; Umbilical Cord - diagnostic imaging; Umbilical Cord - surgery; umbilical cord occlusion; Pregnancy; Occlusion; Transfusion; Donor; Gynecology; Fetus; Recipient; Umbilical cord; Obstetrics; Comparative study; Twin
• ISSN: 0960-7692; 1469-0705
• DOI: 10.1002/uog.1034

Objectives
To compare the technical characteristics and perinatal outcomes of selected twin–twin transfusion syndrome (TTTS) cases treated with primary umbilical cord occlusion (UCO) of the donor vs. recipient twin.
Methods
TTTS patients who underwent primary UCO via ultrasound endoscopic‐guided umbilical cord ligation (UCL) or endoscopic umbilical cord photocoagulation (UCP) were eligible for the study. Primary UCO was offered only if a discordant lethal anomaly was present or by patient choice in TTTS Stages III/IV on the cord of the fetus with abnormal Doppler studies or hydrops.
Results
Primary UCO was performed in 25 TTTS cases between July 1997 and June 2002. UCO was performed in six (24%) donor twins and 19 (76%) recipient twins. UCL was performed in 23 cases and UCP in two cases. Overall, 22 (88%) patients had liveborn infants. There were no differences in cotwin survival (100% vs. 84.2%), median gestational age at delivery (34.8 vs. 33.8 weeks) and preterm premature rupture of membranes rate (16.6% vs. 15.7%) whether the donor or recipient twin, respectively, was the subject of UCO. However, two‐trocar access (50% vs. 5.3%; P = 0.03) and amnioinfusion (83.3% vs. 0%; P < 0.001) were required more often in the UCO of the donor than of the recipient twin, respectively. Operating time (75 vs. 40 min) was significantly longer in UCO of the donor twin (P = 0.04). UCP was more likely to be used in occlusion of the donor's cord (33%) than of the recipient's cord (0%; P = 0.05).
Conclusion
Primary UCO of the donor twin is technically more demanding than that of the recipient twin, but perinatal outcomes of the cotwins are comparable. Copyright © 2004 ISUOG. Published by John Wiley & Sons, Ltd.