Impact of middle cerebral artery pulsatility index on donor survival in twin‐twin transfusion syndrome

作者：Eyal Krispin, Alireza A. Shamshirsaz, Hiba J. Mustafa, Raphael C. Sun, Jimmy Espinoza, Ahmed A. Nassr, Magdalena Sanz Cortés, Chilaka H. Ugoji, Christopher Harman, Özhan Turan, Michael A. Belfort, Roopali Donepudi · 发表于：Prenatal Diagnosis · 年份：2022 · DOI：10.1002/pd.6288 · 被引用次数：6 · 研究领域：Assisted Reproductive Technology and Twin Pregnancy、Retinopathy of Prematurity Studies、Preterm Birth and Chorioamnionitis

OBJECTIVE: To assess outcomes in twin-twin transfusion syndrome (TTTS) according to middle cerebral artery pulsatility index (MCA-PI) prior to fetoscopic laser photocoagulation (FLPC) surgery. METHODS: A retrospective cohort analysis of monochorionic-twin pregnancies complicated by TTTS who underwent FLPC at two fetal centers (2012-2021). The cohort was stratified according to abnormal MCA-PI of the donor twin, defined as below fifth centile for gestational age. RESULTS: Abnormal MCA-PI of the donor twin was detected in 46 (17.7%) cases compared to 213 (83.3%) controls with no such abnormality. The abnormal PI group presented with higher rates of sFGR (56.5% vs. 36.8% in controls, p = 0.014) and lower donor survival rates within 48 h after FLPC (73.9 vs. 86.8%, p = 0.029). Donor twin survival rates at the time of delivery and 30 days after birth were lower in the abnormal MCA-PI. Multivariate logistic regression analysis controlling for sFGR and MCA-PI <fifth centile demonstrated the latter to be independently associated with lower survival rates at the time of delivery and 30 days after birth [OR = 0.497 95%CI (0.250-0.986) p = 0.045, and OR = 0.499 95%CI (0.252-0.986), p = 0.046, respectively]. Recipient's survival rates did not differ between the groups. CONCLUSIONS: Donor survival at the time of delivery and 30 days after birth was lower in TTTS cases with MCA-PI<fifth centile for gestational age prior to laser surgery. This parameter may be considered when evaluating pro...