Prediction of neonatal outcome of TTTS by fetal heart and Doppler ultrasound parameters before and after laser treatment

• Published in: Prenatal diagnosis Vol. 36; no. 13; pp. 1199 - 1205
• Main Authors: Delabaere, A., Leduc, F., Reboul, Q., Fuchs, F., Wavrant, S., Fouron, J. C., Audibert, F.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01-12-2016; Wiley
• Subjects: Echocardiography; Female; Fetal Heart - diagnostic imaging; Fetal Heart - physiopathology; Fetofetal Transfusion - diagnostic imaging; Fetofetal Transfusion - mortality; Fetofetal Transfusion - surgery; Fetoscopy; Gestational Age; Gynecology and obstetrics; Human health and pathology; Humans; Laser Coagulation; Life Sciences; Pregnancy; Prognosis; Pulsatile Flow; Retrospective Studies; Treatment Outcome; Twins; Ultrasonography, Prenatal; Umbilical Arteries - physiopathology
• ISSN: 0197-3851; 1097-0223
• DOI: 10.1002/pd.4956

Objectives
To determine the prognostic value of fetal Doppler and echocardiographic parameters for neonatal survival up to 30 days after laser coagulation in monochorionic pregnancies complicated by twin–twin transfusion syndrome (TTTS).
Methods
Fetal echocardiography and outcome data of consecutive cases of TTTS treated by laser were retrospectively reviewed. Hemodynamic and cardiac function parameters were collected before and after laser.
Results
Between February 2006 and January 2015, 106 fetoscopic laser were performed. The final analysis was limited to cases with ultrasound within 2 days before laser (n = 77) and 4 weeks after laser (n = 86). Overall neonatal survival rate was 64.9% (135/208) and 77.9% of pregnancies (81/104) had at least one baby alive. For the recipient twin, the preoperative predictors of neonatal survival were umbilical artery (UA) pulsatility index (PI), cerebro‐placental PI ratio, UA end diastolic flow (EDF), ductus venosus a‐wave, right ventricular myocardial performance index (RV‐MPI) and CHOP score. The postoperative predictors of donor survival were donor RV‐MPI and recipient UA EDF, umbilical vein pulsations, tricuspid regurgitation, cardiac hypertrophy and CHOP score.
Conclusion
The hemodynamic predictors of postnatal survival after laser were preoperative signs of recipient cardiomyopathy and postoperative signs of cardiac overload in both twins. © 2016 John Wiley & Sons, Ltd.
What's already known about this topic?
Pre‐operative echocardiography is able to recognize increasing severity of the syndrome‐related cardiomyopathy in TTTS recipient twin. Few studies have investigated the prognostic value of recipient cardiac parameters before and after laser treatment for TTTS.
What does this study add?
Our results show that pre‐operative recipient cardiomyopathy, and postoperative cardiomyopathy in one or both twins are associated with adverse perinatal outcome of donor twin.