Predictors of Single Donor Demise Following Laser Ablation in TTTS with Selective Fetal Growth Restriction

To investigate preoperative and operative factors predictive of donor demise after laser ablation in a cohort of only selective fetal growth restriction (sFGR) coexistent with twin-to-twin transfusion syndrome (TTTS). Retrospective cohort study of prospectively collected data of consecutive TTTS cases that underwent fetoscopic laser surgery (FLS) between 2012 and 2020 at two high specialized fetal centers. Triplet pregnancies, normally grown twins, dual twin demise after FLS, and missing records were excluded. sFGR was defined using Delphi criteria. Preoperative and operative factors associated with donor demise were identified by regression analysis. Receiver operating characteristic (ROC) curve analysis for the regression models were generated. A total of 209 pregnancies of sFGR with TTTS were included in the final analysis. Significant variables between TTTS only compared to TTTS with sFGR were Quintero staging (p=0.001), inter-twin fetal weight discordance > 35% (p=0.005), delta umbilical artery (UA) pulsatility index (PI) (p < 0.001), UA PI > 95% (p < 0.001), and UA absent/reversed end diastolic velocity (p=0.002). Following the regression analysis, significant variables that predicted sFGR donor demise were delta UA PI [OR: 6.8 (95% CI 2.9-15.5), p < 0.001], and inter-twin fetal weight discordance >35% [OR: 2.08 (95% CI 1.03-4.2), p=0.04]. The area under the curve for the regression model was 0.87 in the ROC analysis. Preoperative factors predicted donor demise after laser ablation in a cohort of sFGR with TTTS. Delta UA PI has a promising role in that prediction. Further investigation is required.View Large Image Figure ViewerDownload Hi-res image Download (PPT)