Stage I twin-twin transfusion syndrome with intermittent umbilical artery Doppler abnormalities

IF 3.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

American Journal of Obstetrics & Gynecology Mfm Pub Date : 2025-08-15 DOI:10.1016/j.ajogmf.2025.101754

Raphael C. Sun MD , Andrew H. Chon MD , Arlyn Llanes , Lisa M. Korst MD, PhD , Martha A. Monson MD , Eftichia V. Kontopoulos MD , Rubén A. Quintero MD , Ramen H. Chmait MD

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引用次数: 0

Abstract

Background

Twin-to-twin transfusion syndrome (TTTS) is a rare condition that occurs in approximately 9% to 15% of monochorionic diamniotic twin pregnancies. The Quintero staging system was established to categorize the severity of this disease. Published outcomes for selective laser photocoagulation of communicating vessels demonstrate a significant difference in dual survival outcomes among the different stages of TTTS. Per Quintero staging, Stage I TTTS includes those with donor twin umbilical artery (UA) intermittent, absent, or reversed end diastolic velocity (AREDV), whereas patients with persistent donor twin UA-AREDV are classified as Stage III. This distinction between intermittent and persistent UA-AREDV appears to have been variably interpreted since the original publication.

Objective

Our objective was to compare laser-treatment outcomes in Stage I patients with intermittent UA-AREDV vs Stage I patients with a normal UA waveform; Stage III patients with persistent donor twin UA-AREDV were used for comparison. Because arterio-arterial communications (AA) have been associated with postoperative donor demise, the rate of such vascular communications was also assessed within the 3 groups.

Study Design

Three groups of monochorionic diamniotic twins with TTTS that was treated with laser surgery (2006–2023) were analyzed for the primary outcome of donor twin intrauterine fetal demise (IUFD): Stage I with preoperative normal donor UA flow (Stage-I Normal); Stage I with preoperative intermittent donor UA-AREDV (Stage-I Intermittent); and Stage III with preoperative persistent donor UA-AREDV (Stage-III).

Results

Of 349 study patients, 101 were classified as Stage-I Normal, 36 were Stage-I Intermittent, and 212 were Stage-III. The rate of donor IUFD was lowest in Stage-I Normal vs Stage-I Intermittent and Stage-III groups: 3.0% vs 25.0% vs 29.2%, P<.0001. At least one survival did not differ among the 3 groups; dual survival was highest for Stage-1-Normal (97.0% vs 75.0% vs 66.0%, P<.0001) and differed from both Stage-I Intermittent and Stage-III groups in pairwise comparisons. AA communications were most common in the Stage-I Intermittent group: 27.7% vs 69.4% vs 42.5%, P<.0001. In a multiple logistic regression model, Stage-I Intermittent patients were 7 times more likely to have donor twin IUFD (Odds ratio [OR] 7.23 [1.69–30.82], P=.0075), as were Stage-III patients (OR 7.24 [2.06–25.47], P=.0020), compared to Stage-I Normal patients. In this same model, independently, patients with AA were 3.6 times more likely to have donor IUFD (OR 3.59 [1.95–6.61]; P<.0001).

Conclusion

TTTS Stage I patients with intermittent UA-AREDV were at increased risk of donor IUFD after laser surgery.

Abstract Image

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伴有间歇脐动脉多普勒异常的I期双胎输血综合征：伴有间歇脐动脉多普勒异常的I期TTTS供体死亡。

背景：双胎输血综合征（TTTS）是一种罕见的疾病，发生在约9%-15%的单绒毛膜双胎妊娠。建立了Quintero分期系统来对这种疾病的严重程度进行分类。已发表的选择性激光光凝交通血管（SLPCV）的结果表明，不同阶段TTTS的双重生存结果存在显著差异。根据Quintero分期，I期TTTS包括供体双脐动脉（UA）间歇性缺失或舒张末期速度逆转（AREDV）的患者，而持续供体双UA-AREDV的患者被归类为III期。间歇性UA-AREDV和持续性UA-AREDV之间的区别似乎自最初发表以来一直有不同的解释。目的：我们的目的是比较间歇性UA- aredv的I期患者与UA波形正常的I期患者的激光治疗结果；持续供体双UA-AREDV的III期患者用于比较。由于动脉动脉通信（AA）与术后供体死亡有关，因此还评估了三组内此类血管通信的发生率。研究设计：对三组接受激光手术治疗的TTTS单绒毛膜双羊膜双胞胎（2006-2023年）的供体双胞胎宫内胎儿死亡（IUFD）的主要结局进行分析：ⅰ期术前供体UA流量正常（ⅰ期正常）；I期术前间断供体UA-AREDV （I期间断）；III期术前持续供体UA-AREDV （III期）。结果：在349例研究患者中，101例为i期正常，36例为i期间歇，212例为iii期。供体IUFD发生率在I期正常组、I期间歇组和iii期组最低：3.0% vs 25.0% vs 29.2%。结论：间歇性UA-AREDV的TTTS I期患者在激光手术后供体IUFD的风险增加。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Obstetrics & Gynecology Mfm Medicine-Medicine (all)

CiteScore

7.40

自引率

3.20%

发文量

254

审稿时长

40 days

期刊介绍： The American Journal of Obstetrics and Gynecology (AJOG) is a highly esteemed publication with two companion titles. One of these is the American Journal of Obstetrics and Gynecology Maternal-Fetal Medicine (AJOG MFM), which is dedicated to the latest research in the field of maternal-fetal medicine, specifically concerning high-risk pregnancies. The journal encompasses a wide range of topics, including: Maternal Complications: It addresses significant studies that have the potential to change clinical practice regarding complications faced by pregnant women. Fetal Complications: The journal covers prenatal diagnosis, ultrasound, and genetic issues related to the fetus, providing insights into the management and care of fetal health. Prenatal Care: It discusses the best practices in prenatal care to ensure the health and well-being of both the mother and the unborn child. Intrapartum Care: It provides guidance on the care provided during the childbirth process, which is critical for the safety of both mother and baby. Postpartum Issues: The journal also tackles issues that arise after childbirth, focusing on the postpartum period and its implications for maternal health. AJOG MFM serves as a reliable forum for peer-reviewed research, with a preference for randomized trials and meta-analyses. The goal is to equip researchers and clinicians with the most current information and evidence-based strategies to effectively manage high-risk pregnancies and to provide the best possible care for mothers and their unborn children.