Twin and Cotwin Predictors of Fetal Demise After Laser Photocoagulation Therapy in Advanced Stage Twin–Twin Transfusion Syndrome: A Fetal Heart Society Research Collaborative Study
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Current models to predict outcomes in advanced twin-twin transfusion syndrome are limited. We hypothesized that twin and cotwin echocardiographic factors would improve model performance for donor and recipient demise following laser photocoagulation therapy. METHODS: We performed a multicenter retrospective cohort study of stage 3 to 4 twin-twin transfusion syndrome referred for laser photocoagulation therapy. Fetal echocardiograms were analyzed at a core laboratory. We used multivariable logistic regression models to select variables used for generalized linear mixed-effects modeling. Separate models were developed for donor and recipient demise, using both twin and cotwin variables. Models were assessed by area under the receiver operating characteristic curves. RESULTS: <0.001). Final model variables for donor demise were donor fetal weight, nifedipine administration, umbilical arterial and venous flow patterns, donor cardiac output, left ventricular myocardial performance index, recipient deepest vertical pocket, recipient chest/thoracic ratio, recipient cardiac output, and recipient ductus venosus flow pattern; and for recipient demise were nifedipine use, recipient combined cardiac output, recipient left ventricular myocardial performance index, recipient umbilical arterial flow pattern, and donor left ventricular myocardial performance index. Including cotwin variables in models for donor and recipient demise improved performance. Final model area under the receiver operating characteristic curves were 0.82 for both donor and recipient demise. CONCLUSIONS: This is the largest multicenter study to rigorously evaluate echocardiographic metrics associated with fetal demise in twin-twin transfusion syndrome and the first to identify intertwin parameters associated with cotwin demise.
Institutions: Stanford Medicine, Stanford University, Kaiser Permanente, Baylor College of Medicine, University of Colorado Anschutz, University of Colorado Denver, Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, University of Cincinnati, University of California, San Francisco, UCSF Benioff Children's Hospital
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,810
OpenAlex ID: W7116835518