306 - Perinatal and neonatal outcomes for fetoscopic laser ablation for the treatment of twin-twin transfusion syndrome at Advocate Children’s Hospital – Park Ridge

Poster Number: 306
Publication Number: 306.441

Diamond Ling, Advocate Children's Hospital - Park Ridge, Park Ridge, IL, United States; Tabitha Tate, Advocate Children's Hospital - Park Ridge, Chicago, IL, United States; Alexandra Phelps, Advocate Lutheran General Hospital, Park Ridge, IL, United States; Suwan Mehra, Advocate Children's Hospital - Park Ridge, Park Ridge, IL, United States; Preetha Prazad, Advocate Children's Hospital - Park Ridge, Park Ridge, IL, United States

Background: Twin-Twin Transfusion syndrome (TTTS) is a complication of monochorionic multi-gestational pregnancies associated with a high mortality rates and neonatal morbidities. Placental fetoscopic laser ablation (FLA) disrupts the communication between the fetuses and improves outcomes. Procedural risks include preterm premature rupture of membranes (PPROM) and prematurity.

Objective: To describe perinatal and neonatal outcomes in patients with TTTS treated with FLA at Advocate Children’s Hospital.

Design/Methods: Retrospective chart review of all patients and their neonates from 2011-2020 at Advocate Children’s Hospital—Park Ridge. Data analyzed using Chi-square tests and Mann-Whitney t-tests.

Results:
Study analyzed results from 76 maternal subjects and their 129 liveborn infants. 75 cases met criteria for TTTS by Quintero staging and were predominantly stage III (53%); there was 1 case of Twin Anemia Polycythemia Sequence (TAPs).  

Mean gestational age (GA) at time of FLA was 21±3 weeks (wks). Post procedure complications rates were similar to those previously reported; 5% developed post laser TAPs (vs 0-9%), and 5% developed TTTS recurrence (vs 1-9%). Our rates of intrauterine fetal demise (IUFD) were higher (26% vs 7-17%); majority of which were of a single fetus (85%) and the donor fetus (65%). Mean GA at time of demise was 22±4 wks with most occurring shortly after FLA (Median of 1±21 days). There was a statistically significant association between IUFD and TTTS staging (p=0.04). 29% of cases were complicated by PPROM with mean GA 28±4 wks at time of rupture. 

Our survival rates of at least one twin were higher at 96% than those previously reported (70-80%); of these, the survival rate of both twins of 76%, also higher compared to 35-60%. Mean GA at birth was 32±4 wks. Neonatal mortality rate was 9% with a mean corrected GA of 32±16 wks at time of death. Overall neonatal morbidity rate was 33%; this included intraventricular hemorrhage, polycythemia, anemia, sepsis, cardiac and renal dysfunction. There was a statistically significant association between neonatal mortality and morbidity with lower GA (p < 0.0001).  
Conclusion(s): Overall, our institutional outcomes for FLA for the treatment of TTTS were encouraging, with higher rates of fetal survival to delivery of at least one twin. Our increased rate or IUFD may be due to more patients with advanced staging. Neonatal morbidity and mortality were associated with lower GA at time delivery. Future study will examine outcomes that may be correlated with specific FLA techniques.