ArticleFetal diagnosis and therapy2025
Pre-Operative Predictors of Survival in Twin-Twin Transfusion Syndrome Undergoing Fetoscopic Laser Treatment.
Article in Fetal diagnosis and therapy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
1 citing paper in PubMed.
- Impact of preoperative second-trimester vaginal bleeding on operative factors and outcomes in patients undergoing laser for twin-twin transfusion syndrome.Pregnancy (Hoboken, N.J.) · 2026Article
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11 authors.
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Abstract
introductionLimited data exist regarding the effect of pre-operative risk factors on fetal survival for patients undergoing fetoscopic laser photocoagulation (FLP) for twin-twin transfusion syndrome (TTTS). The primary objective of this study was to determine the pre-operative variables predictive of single and dual fetal survival at birth for subjects treated with laser for TTTS. The secondary objective was to determine the combined effect of multiple risk factors on single and dual fetal survival at birth.
methodsThis was a prospective cohort study of TTTS pregnancies treated with FLP between 2001 and 2023. Cases were identified through the Monochorionic Twin Pregnancy Registry of the North American Fetal Therapy Network. Several pre-operative risk factors were evaluated, including maternal body mass index, gestational age at laser, fetal growth restriction (FGR), cervical length, placental location, and TTTS stage. Higher order multiples, fetal anomalies, karyotypic abnormalities, and cases with missing data were excluded. Risk factors influencing survival were assessed with uni- and multi-variate regression analyses. The predicted probability of single/dual survival based on these risk factors was assessed with multiple logistic regression analysis.
resultsOf 2,728 FLP cases, 1,066 met inclusion criteria. Dual survival is reduced in stage 3 and 4 disease compared to stage 1 and 2 (OR 0.75: 0.58, 0.98; p = 0.032) with the lowest survival in all stages occurring with FGR. An anterior placenta (aOR 0.58: 0.37, 0.91; p = 0.017) and FGR <10th percentile (aOR 0.57: 0.35, 0.92; p = 0.02) were independent predictors of reduced survival. With regression modeling, sequential addition of any pre-operative risk factor progressively reduces survival of at least one or both twins.
conclusionsIn this large registry, anterior placental location and FGR were most predictive of reduced survival for both twins. As the number of pre-operative risk factors increases for a given TTTS case, there is a progressive reduction in survival probability and these reported probability rates may be useful in counseling patients.
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