Perinatal and long-term outcome of endoscopic laser surgery for twin-twin transfusion syndrome with and without selective fetal growth restriction: A retrospective cohort study.

OBJECTIVE: Report survival rates, neonatal mortality and morbidity and long-term outcomes of monochorionic (MC) twin pregnancies complicated by twin-to-twin transfusion syndrome (TTTS) or TTTS plus selective fetal growth restriction (sFGR) treated by endoscopic laser surgery. METHODS: Retrospective cohort study including 149 MC twin pregnancies complicated by TTTS or TTTS plus sFGR.Medical records were reviewed for survival rates, neonatal mortality, neonatal morbidity and long-term outcomes at 2 and 6 years of age. RESULTS: Survival of both babies was higher in the TTTS group than in the TTTS plus sFGR group (72.9%vs.54.8%); survival of at least one baby was similar in the two groups (90.7% and 88.1%). The incidence of severe neurological disability was not significantly different between TTTS and TTTS plus fetal growth restriction group at both stages, 1.9% versus 2.3% (p-value = 1) and 3.4%vs6.1% (p-value = 0.31). Multivariable analysis demonstrated that intact neurological outcome at 2 years of age was related with gestational age (GA) at birth and z score birthweight (Z BW), and at 6 years of age with GA at birth, Z BW and TTTS stage4. sFGR or abnormal brain findings at neonatal ultrasound were not related with impaired neurological outcome at two or 6 years of age. CONCLUSIONS: In pregnancies with TTTS and TTTS plus sFGR survival of at least one baby and long-term neurological outcome are comparable between both groups.

Analysis of secondary ultrasound markers in the first trimester before chorionic villus sampling.

OBJECTIVE: To evaluate detection and false-positive rates of the ultrasound markers-nasal bone (NB), ductus venosus (DV) flow and tricuspid regurgitation (TR)-during the first trimester in a population at high genetic risk, and to study the influence of a two-stage screening policy alter previous combined screening on the rate of invasive procedures. METHODS: A total of 333 chorionic villus samples were obtained in singleton pregnancies. Before biopsy, the ultrasound markers-NB, DV, and TR-were assessed, although the findings were not used to recalculate the previously determined risk for Down syndrome. RESULTS: Detection and false-positive rates for Down syndrome were 63.2% and 3.4% for NB, 65% and 3.1% for DV, and 50% and 2.1% for TR. All three markers were normal in 30% [84/277, 95% confidence interval (CI) 25%-36%] of chorionic villus sampling (CVS) cases performed for abnormal findings at the first trimester genetic screen, with 0% (0/20, 95% CI 0%-17%) false-negative rate for Down syndrome. CONCLUSION: Assessment of secondary ultrasound markers is feasible in clinical practice and their use could reduce the number of unnecessary invasive procedures by 30%.