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Prediction of survival after fetoscopic laser surgery for early-onset twin-to-twin transfusion syndrome

2026-02Artigo científico Acesso aberto
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dc.contributor.authorPrasad, S.
dc.contributor.authorSileo, F. G.
dc.contributor.authorBinder, J.
dc.contributor.authorBrunelli, E.
dc.contributor.authorChianchiano, N.
dc.contributor.authorCoutinho, C. M.
dc.contributor.authorD'Antonio, F.
dc.contributor.authorDöbert, M.
dc.contributor.authorFichera, A.
dc.contributor.authorGielchinsky, Y.
dc.contributor.authorHecher, K.
dc.contributor.authorIacovella, C.
dc.contributor.authorMalone, S.
dc.contributor.authorMartinez-Varea, A.
dc.contributor.authorNørgaard, L. N.
dc.contributor.authorRodo, C.
dc.contributor.authorSimões, T.
dc.contributor.authorSlaghekke, F.
dc.contributor.authorYinon, Y.
dc.contributor.authorKhalil, A.
dc.contributor.authorBahlmann, F.
dc.contributor.authorCarreras, E.
dc.contributor.authorAlletti, S. G.
dc.contributor.authorYaghi, O.
dc.contributor.authorLopriore, E.
dc.contributor.authorOkido, M. M.
dc.contributor.authorMarkovich, A.
dc.contributor.authorMohammed, D.
dc.contributor.authorMoreno-Perez, E.
dc.contributor.authorPrefumo, F.
dc.contributor.authorQueirós, A.
dc.contributor.authorRosello, J. M.
dc.contributor.authorSundberg, K.
dc.contributor.authorYeoh, M.
dc.contributor.authorYoussef, A.
dc.contributor.authorUlusoy, C. O.
dc.contributor.institutionNOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)
dc.contributor.pblJohn Wiley and Sons Ltd
dc.date.accessioned2026-03-11T11:44:02Z
dc.date.available2026-03-11T11:44:02Z
dc.date.issued2026-02
dc.descriptionPublisher Copyright: © 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.
dc.description.abstractObjective: 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.en
dc.description.versionpublishersversion
dc.description.versionpublished
dc.format.extent394094
dc.identifier.doi10.1002/uog.70178
dc.identifier.issn0960-7692
dc.identifier.otherPURE: 154943889
dc.identifier.otherPURE UUID: 9c0ec02e-ac1a-4ee6-8be6-67b60e5d3607
dc.identifier.otherScopus: 105030227685
dc.identifier.urihttp://hdl.handle.net/10362/201251
dc.identifier.urlhttps://www.scopus.com/pages/publications/105030227685
dc.language.isoeng
dc.peerreviewedyes
dc.subjectearly
dc.subjectintrauterine demise
dc.subjectlaser
dc.subjectMCDA
dc.subjectmonochorionic diamniotic
dc.subjectsurvival
dc.subjectTTTS
dc.subjecttwin
dc.subjecttwin-to-twin transfusion syndrome
dc.subjectRadiological and Ultrasound Technology
dc.subjectReproductive Medicine
dc.subjectRadiology Nuclear Medicine and imaging
dc.subjectObstetrics and Gynaecology
dc.titlePrediction of survival after fetoscopic laser surgery for early-onset twin-to-twin transfusion syndromeen
dc.typejournal article
degois.publication.firstPage
degois.publication.lastPage
degois.publication.titleUltrasound in Obstetrics and Gynecology
degois.publication.volume67
dspace.entity.typePublication
rcaap.rightsopenAccess

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