Comparison of Twin-to-Twin Transfusion Syndrome and Without Selective Fetal Growth Restriction Before Fetoscopic Laser Photocoagulation in Iran

Aims: This study compared two groups of twin pregnancies complicated by twin-to-twin transfusion syndrome (TTTS), with and without selective fetal growth restriction (sFGR), and evaluated the survival rate at ۳۰ days after birth treated with fetoscopic laser photocoagulation (FLP). Materials & Methods: The present study was a retrospective study of ۱۶۴ diamniotic monochorionic twin pregnancies complicated with TTTS and treated with FLP. The sFGR was defined as an estimated fetal weight below the ۱۰th percentile. The independent t-test, Chi-square test, or Fisher's exact test were used for statistical analysis. Multiple logistic regression analysis was performed to identify ۳۰-day donor twin survival risk factors for the entire study population. The significance level was determined at p<۰.۰۵. Findings: Of the studied cases, ۴۵.۱% had only TTTS, while ۵۴.۹% had both TTTS and sFGR. .There was a significant difference (p<۰.۰۰۱) in the distribution of Quintero stages and maternal age during the intervention (p=۰.۰۱) between the two groups. The sFGR before laser surgery in TTTS patients was associated with reduced donor survival. The multivariate analysis revealed that gestational age at delivery (OR=۰.۸۱, ۹۵%CI:۰.۷-۰.۸) and sFGR (OR=۰.۴۳, ۹۵%CI:۰.۲-۰.۸) were significantly associated with donor survival. Conclusion: The sFGR before FLP is present in approximately ۵۵% of TTTS cases, which is caused by normal placental abnormalities. TTTS with sFGR is associated with reduced donor embryo survival. Gestational age at delivery and sFGR are important factors affecting donor survival ۳۰ days after birth. Performing successive ultrasounds after diagnosing monochorionic twin pregnancies is essential for timely identification, correct management, and treatment.

Keywords:

Monochorionic twins , Selective fetal growth restriction , Twin blood transfusion syndrome , Fetoscopic laser photocoagulation