437: Fetal pleuroamniotic shunting for macrocystic lung lesions (original) (raw)

2011, American Journal of Obstetrics and Gynecology

Monochorionic twins have increased perinatal morbidity and mortality due to a variety of factors, including twin-twin transfusion syndrome (TTTS) and increased risk of congenital anomalies. The objective of this study was to describe the non-cardiac anomalies in monochorionic twins afflicted with TTTS. STUDY DESIGN: This was a retrospective study of 221 consecutive cases of TTTS treated with laser surgery between March 2006 and May 2010. Major versus minor non-cardiac congenital anomalies were classified according to the Western Australian Birth Defects Registry system (BMJ 1997;315:1260-1265). Because of the secondary cardiac derangements that arise in association with TTTS, cases with cardiac anomalies were excluded from the analysis. Anomalies were diagnosed by antepartum ultrasound and/or review of neonatal medical records. Statistical analyses were performed using Fisher's exact and chi square tests. A p-value Ͻ 0.05 was considered significant. RESULTS: Non-cardiac congenital anomalies were identified in a total of 24 individual twins (5.4%). There was a significantly increased rate of non-cardiac anomalies in the donor twin (8.1%, 18/221) versus the recipient twin (2.7%, 6/221, pϭ0.019). Comparing cases with and without non-cardiac anomalies, there were no differences in frequency of Quintero Stage III/IV cases (68% vs. 67%, pϭ1.0), gestational week of laser surgery (20.2 Ϯ 1.9 vs. 20.7 Ϯ 2.4, pϭ0.39), gestational week at delivery (32.0 Ϯ 4.6 vs. 32.4 Ϯ 4.3, pϭ0.75), 30-day survival of the donor (68% vs. 74%, pϭ0.84), and 30-day survival of the recipient (73% vs. 83%, pϭ0.36), respectively. Of the 18 donor fetuses with anomalies, 10 (55.6%) were considered major. Of the 6 recipient fetuses with anomalies, 3 (50%) were major. CONCLUSIONS: An increased incidence of non-cardiac structural anomalies was found in donor twins versus recipient twins in cases of TTTS. The etiology of this difference is unknown, but it may in part be related to early blood flow disturbances seen in twin-twin transfusion syndrome.