Long term outcome of twin-twin transfusion syndrome
R B Cincottaa, P H Grayb c, G Phythianb, Y M Rogersc, F Y Chana
a Department of
Maternal-Fetal Medicine, Mater Mother's Hospital, Raymond Terrace,
South Brisbane, Queensland, Australia, b Department of Neonatology, c Growth and Development Unit,
Mater Children's Hospital, Raymond Terrace, South Brisbane,
Queensland, Australia
Correspondence to: Dr Cincotta, Department of Maternal-Fetal Medicine, Raymond Terrace, South Brisbane, Queensland 4101, Australia 1neoap{at}mater.org.au
Accepted 3 February
2000
AIMS
To compare the
perinatal mortality and morbidity of infants with twin-twin transfusion
syndrome (TTTS) with those of gestation matched twin controls and to
assess the neurodevelopmental outcome of surviving twins with TTTS.
METHODSA cohort of 17 consecutive pregnancies with TTTS was enrolled over three years
together with gestation matched twin pregnancies unaffected by TTTS.
Serial amnioreduction for the TTTS pregnancies was performed as
appropriate. Perinatal death and neonatal morbidities were recorded for
both the TTTS cohort and controls. The TTTS survivors had
neurodevelopmental follow up to at least 2 years of age.
RESULTSIn 12 of the
pregnancies, serial amniocenteses were performed, but, in five, the
infants were born before intervention. The mean gestational age at
delivery was 29.1 weeks (range 23-36). There were five intrauterine
deaths in the TTTS cohort and six neonatal deaths (survival 68%). In
the control group, there was one intrauterine death and five neonatal
deaths (survival 82%). Infants in the TTTS group had a greater
requirement for inotropes (p = 0.04) and a higher incidence of renal
failure (p = 0.005). Periventricular leucomalacia and cerebral
atrophy were seen in 17% of the TTTS group, but none of the controls
(p = 0.03). The 23 surviving TTTS infants were all followed up, with
22% having significant neurological morbidity: cerebral palsy and
global developmental delay.
CONCLUSIONSTwins with
TTTS have high perinatal mortality and neonatal morbidity, and long
term neurodevelopmental morbidity in survivors is high. Further
investigation into the pathogenesis and management of TTTS is required.
Keywords: twin-twin transfusion syndrome; amnioreduction; morbidity; neurodevelopmental outcome
© 2000 by Archives of Disease in Childhood
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