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| Formato: | Recurso digital |
| Idioma: | inglês |
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2026
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| Acesso em linha: | https://doi.org/10.1002/uog.70178 |
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| author | Prasad, S. Sileo, F.G. Binder, J. Brunelli, E. Chianchiano, N. Coutinho, C.M. D'Antonio, F. Döbert, M. Fichera, A. Gielchinsky, Y. Hecher, K. Iacovella, C. Malone, S. Martínez-Varea, A. Norgaard, L.N. Rodo, C. Simões, T. Slaghekke, F. Yinon, Y. Khalil, A. Bahlmann, F. Carreras Moratonas, E. Alletti, S.G. Yaghi, O. Lopriore, E. Okido, M.M. Markovich, A. Mohammed, D. Moreno-Perez, E. Prefumo, F. Queirós, A. Rosello, J.M. Sundberg, K. Yeoh, M. Youssef, A. Ulusoy, C.O. |
| author_facet | Prasad, S. Sileo, F.G. Binder, J. Brunelli, E. Chianchiano, N. Coutinho, C.M. D'Antonio, F. Döbert, M. Fichera, A. Gielchinsky, Y. Hecher, K. Iacovella, C. Malone, S. Martínez-Varea, A. Norgaard, L.N. Rodo, C. Simões, T. Slaghekke, F. Yinon, Y. Khalil, A. Bahlmann, F. Carreras Moratonas, E. Alletti, S.G. Yaghi, O. Lopriore, E. Okido, M.M. Markovich, A. Mohammed, D. Moreno-Perez, E. Prefumo, F. Queirós, A. Rosello, J.M. Sundberg, K. Yeoh, M. Youssef, A. Ulusoy, C.O. |
| contents | Objective: Data on early-onset twin-to-twin transfusion syndrome (TTTS) are scarce and, therefore, evidence-based counseling and management of these pregnancies are challenging. This study aimed to investigate survival rates and establish predictors of survival after fetoscopic laser surgery (FLS) for early-onset TTTS. Methods: This was an international multicenter retrospective cohort study of monochorionic diamniotic twin pregnancies complicated by TTTS diagnosed before 18 + 0 weeks' gestation that underwent FLS. The primary outcome was dual-twin survival at 28 days after birth. Secondary outcomes included survival of at least one twin and dual-twin demise at 28 days after birth. Monoamniotic twin, triplet and higher-order multiple pregnancies, pregnancies with chromosomal or structural fetal anomaly and TTTS cases not treated by FLS were excluded. Pre-, intra- and postoperative characteristics were analyzed using multivariable logistic regression analysis. Discriminative performance was assessed using receiver-operating-characteristics-curve analysis. Results: A total of 485 cases of early-onset TTTS that underwent FLS were included. The rates of dual-twin survival and survival of at least one twin at 28 days after birth were 51.5% (250/485) and 76.7% (372/485), respectively, while 23.3% (113/485) of cases resulted in dual-twin demise. Multivariable logistic regression analysis showed that absent or reversed end-diastolic flow (AREDF) in the donor umbilical artery (adjusted odds ratio (aOR), 0.487 (95% CI, 0.273–0.867)) and absent or reversed a-wave in the donor ductus venosus (aOR, 0.299 (95% CI, 0.110–0.810)) at the time of TTTS diagnosis were associated independently with decreased odds of dual survival, while higher gestational age at birth was associated with increased odds of both dual-twin survival (aOR, 1.172 (95% CI, 1.117–1.229)) and survival of at least one twin (aOR, 2.053 (95% CI, 1.699–2.481)). The model for dual-twin survival showed modest discriminative performance with poor overall fit. Conclusions: The presence of AREDF in the donor umbilical artery and absent or reversed a-wave in the donor ductus venosus, at the time of diagnosis of TTTS, and lower gestational age at birth were independent adverse predictors for dual-twin survival following FLS in cases of TTTS diagnosed before 18 weeks. Future studies should explore the impact of surgical technique on survival rates. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. |
| format | Recurso digital |
| id | zenodo_https___doi_org_10_1002_uog_70178 |
| institution | Zenodo |
| language | eng |
| publishDate | 2026 |
| publisher | Zenodo |
| record_format | zenodo |
| spellingShingle | Prediction of survival after fetoscopic laser surgery for early-onset twin-to-twin transfusion syndrome Prasad, S. Sileo, F.G. Binder, J. Brunelli, E. Chianchiano, N. Coutinho, C.M. D'Antonio, F. Döbert, M. Fichera, A. Gielchinsky, Y. Hecher, K. Iacovella, C. Malone, S. Martínez-Varea, A. Norgaard, L.N. Rodo, C. Simões, T. Slaghekke, F. Yinon, Y. Khalil, A. Bahlmann, F. Carreras Moratonas, E. Alletti, S.G. Yaghi, O. Lopriore, E. Okido, M.M. Markovich, A. Mohammed, D. Moreno-Perez, E. Prefumo, F. Queirós, A. Rosello, J.M. Sundberg, K. Yeoh, M. Youssef, A. Ulusoy, C.O. early intrauterine demise laser MCDA monochorionic diamniotic survival TTTS twin twin-to-twin transfusion syndrome Objective: Data on early-onset twin-to-twin transfusion syndrome (TTTS) are scarce and, therefore, evidence-based counseling and management of these pregnancies are challenging. This study aimed to investigate survival rates and establish predictors of survival after fetoscopic laser surgery (FLS) for early-onset TTTS. Methods: This was an international multicenter retrospective cohort study of monochorionic diamniotic twin pregnancies complicated by TTTS diagnosed before 18 + 0 weeks' gestation that underwent FLS. The primary outcome was dual-twin survival at 28 days after birth. Secondary outcomes included survival of at least one twin and dual-twin demise at 28 days after birth. Monoamniotic twin, triplet and higher-order multiple pregnancies, pregnancies with chromosomal or structural fetal anomaly and TTTS cases not treated by FLS were excluded. Pre-, intra- and postoperative characteristics were analyzed using multivariable logistic regression analysis. Discriminative performance was assessed using receiver-operating-characteristics-curve analysis. Results: A total of 485 cases of early-onset TTTS that underwent FLS were included. The rates of dual-twin survival and survival of at least one twin at 28 days after birth were 51.5% (250/485) and 76.7% (372/485), respectively, while 23.3% (113/485) of cases resulted in dual-twin demise. Multivariable logistic regression analysis showed that absent or reversed end-diastolic flow (AREDF) in the donor umbilical artery (adjusted odds ratio (aOR), 0.487 (95% CI, 0.273–0.867)) and absent or reversed a-wave in the donor ductus venosus (aOR, 0.299 (95% CI, 0.110–0.810)) at the time of TTTS diagnosis were associated independently with decreased odds of dual survival, while higher gestational age at birth was associated with increased odds of both dual-twin survival (aOR, 1.172 (95% CI, 1.117–1.229)) and survival of at least one twin (aOR, 2.053 (95% CI, 1.699–2.481)). The model for dual-twin survival showed modest discriminative performance with poor overall fit. Conclusions: The presence of AREDF in the donor umbilical artery and absent or reversed a-wave in the donor ductus venosus, at the time of diagnosis of TTTS, and lower gestational age at birth were independent adverse predictors for dual-twin survival following FLS in cases of TTTS diagnosed before 18 weeks. Future studies should explore the impact of surgical technique on survival rates. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. |
| title | Prediction of survival after fetoscopic laser surgery for early-onset twin-to-twin transfusion syndrome |
| topic | early intrauterine demise laser MCDA monochorionic diamniotic survival TTTS twin twin-to-twin transfusion syndrome |
| url | https://doi.org/10.1002/uog.70178 |