Umbilical cord occlusion of the donor versus recipient fetus in twin-twin transfusion syndrome

M. Nakata, R. H. Chmait, R. A. Quintero

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objectives: To compare the technical characteristics and perinatal outcomes of selected twin-twin transfusion syndrome (TTTS) cases treated with primary umbilical cord occlusion (UCO) of the donor vs. recipient twin. Methods: TTTS patients who underwent primary UCO via ultrasound endoscopic-guided umbilical cord ligation (UCL) or endoscopic umbilical cord photocoagulation (UCP) were eligible for the study. Primary UCO was offered only if a discordant lethal anomaly was present or by patient choice in TTTS Stages III/IV on the cord of the fetus with abnormal Doppler studies or hydrops. Results: Primary UCO was performed in 25 TTTS cases between July 1997 and June 2002. UCO was performed in six (24%) donor twins and 19 (76%) recipient twins. UCL was performed in 23 cases and UCP in two cases. Overall, 22 (88%) patients had liveborn infants. There were no differences in cotwin survival (100% vs. 84.2%), median gestational age at delivery (34.8 vs. 33.8 weeks) and preterm premature rupture of membranes rate (16.6% vs. 15.7%) whether the donor or recipient twin, respectively, was the subject of UCO. However, two-trocar access (50% vs. 5.3%; P = 0.03) and amnioinfusion (83.3% vs. 0%; P < 0.001) were required more often in the UCO of the donor than of the recipient twin, respectively. Operating time (75 vs. 40 min) was significantly longer in UCO of the donor twin (P = 0.04). UCP was more likely to be used in occlusion of the donor's cord (33%) than of the recipient's cord (0%; P = 0.05). Conclusion: Primary UCO of the donor twin is technically more demanding than that of the recipient twin, but perinatal outcomes of the cotwins are comparable.

Original languageEnglish
Pages (from-to)446-450
Number of pages5
JournalUltrasound in Obstetrics and Gynecology
Volume23
Issue number5
DOIs
StatePublished - May 1 2004

Fingerprint

transfusion
Fetofetal Transfusion
Umbilical Cord
occlusion
fetuses
Fetus
Tissue Donors
Light Coagulation
Ligation
delivery

Keywords

  • Fetoscopy
  • Twin-twin transfusion syndrome
  • Umbilical cord occlusion

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology
  • Reproductive Medicine
  • Acoustics and Ultrasonics

Cite this

Umbilical cord occlusion of the donor versus recipient fetus in twin-twin transfusion syndrome. / Nakata, M.; Chmait, R. H.; Quintero, R. A.

In: Ultrasound in Obstetrics and Gynecology, Vol. 23, No. 5, 01.05.2004, p. 446-450.

Research output: Contribution to journalArticle

Nakata, M. ; Chmait, R. H. ; Quintero, R. A. / Umbilical cord occlusion of the donor versus recipient fetus in twin-twin transfusion syndrome. In: Ultrasound in Obstetrics and Gynecology. 2004 ; Vol. 23, No. 5. pp. 446-450.
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abstract = "Objectives: To compare the technical characteristics and perinatal outcomes of selected twin-twin transfusion syndrome (TTTS) cases treated with primary umbilical cord occlusion (UCO) of the donor vs. recipient twin. Methods: TTTS patients who underwent primary UCO via ultrasound endoscopic-guided umbilical cord ligation (UCL) or endoscopic umbilical cord photocoagulation (UCP) were eligible for the study. Primary UCO was offered only if a discordant lethal anomaly was present or by patient choice in TTTS Stages III/IV on the cord of the fetus with abnormal Doppler studies or hydrops. Results: Primary UCO was performed in 25 TTTS cases between July 1997 and June 2002. UCO was performed in six (24{\%}) donor twins and 19 (76{\%}) recipient twins. UCL was performed in 23 cases and UCP in two cases. Overall, 22 (88{\%}) patients had liveborn infants. There were no differences in cotwin survival (100{\%} vs. 84.2{\%}), median gestational age at delivery (34.8 vs. 33.8 weeks) and preterm premature rupture of membranes rate (16.6{\%} vs. 15.7{\%}) whether the donor or recipient twin, respectively, was the subject of UCO. However, two-trocar access (50{\%} vs. 5.3{\%}; P = 0.03) and amnioinfusion (83.3{\%} vs. 0{\%}; P < 0.001) were required more often in the UCO of the donor than of the recipient twin, respectively. Operating time (75 vs. 40 min) was significantly longer in UCO of the donor twin (P = 0.04). UCP was more likely to be used in occlusion of the donor's cord (33{\%}) than of the recipient's cord (0{\%}; P = 0.05). Conclusion: Primary UCO of the donor twin is technically more demanding than that of the recipient twin, but perinatal outcomes of the cotwins are comparable.",
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