loading page

Intertwin differences in umbilical artery PI supersede the TTTS Quintero classification in the prediction of infant survival: a retrospective cohort study
  • +9
  • Jimmy Espinoza,
  • Michael Belfort (FETAL MEDICINE ISSUE EDITOR),
  • Alireza Shamshirsaz,
  • Ahmed Nassr,
  • Magdalena Sanz Cortes,
  • Roopali Donepudi,
  • Andres Espinoza,
  • Tiffany Ostovar-Kermani,
  • Rebecca Johnson,
  • Christopher Harman,
  • Halis Ozdemir,
  • Ozhan Turan
Jimmy Espinoza
Baylor College of Medicine and Texas Childrens Hospital Pavilion for Women, Houston, TX, United States
Author Profile
Michael Belfort (FETAL MEDICINE ISSUE EDITOR)
Baylor College of Medicine
Author Profile
Alireza Shamshirsaz
Baylor College of Medicine
Author Profile
Ahmed Nassr
Baylor College of Medicine
Author Profile
Magdalena Sanz Cortes
BAYLOR COLLEGE OF MEDICINE, TEXAS
Author Profile
Roopali Donepudi
Baylor College of Medicine and Texas Childrens Hospital Pavilion for Women, Houston, TX, United States
Author Profile
Andres Espinoza
Baylor College of Medicine and Texas Childrens Hospital Pavilion for Women, Houston, TX, United States
Author Profile
Tiffany Ostovar-Kermani
Baylor College of Medicine and Texas Childrens Hospital Pavilion for Women, Houston, TX, United States
Author Profile
Rebecca Johnson
BCM
Author Profile
Christopher Harman
University of Maryland School of Medicine
Author Profile
Halis Ozdemir
University of Maryland School of Medicine
Author Profile
Ozhan Turan
University of Maryland School of Medicine
Author Profile

Abstract

Objective: To evaluate the role of intertwin differences in umbilical artery (UA) pulsatility index (DUAPI) in predicting infant survival in twin-to-twin transfusion syndrome (TTTS) Design: Retrospective cohort study Setting: Baylor College of Medicine, Texas Children’s Hospital and University of Maryland School of Medicine Population: Women who underwent laser surgery due to TTTS between 2002 and 2018. Methods: Absolute DUAPI were calculated prior to laser surgery. ROC analysis was done to derive a DUAPI cutoff value of 0.4 for the prediction of double infant survival. Regression analyses were performed to evaluate the association of DUAPI <0.4 and infant survival in the whole cohort, in TTTS cases with Quintero stages I/II and in those with Quintero stage III/IV; adjustments for gestational age at delivery, Quintero stage, selective fetal growth restriction (sFGR) and other confounders were done. Main Outcome Measure: Double infant survival to 30 days of life Results: 349 TTTS cases were included. Double twin survival to 30 days was observed in 67% (234/349) of cases. Intertwin DUAPI <0.4 was associated with increased double twin survival in the whole cohort (aOR: 3.40; 95% CI: 2.02-5.70; p<0.001), in women with TTTS Quintero stage I or II (aOR: 3.05; 95% CI: 1.32-7.09; p=0.009) and in women with TTTS Quintero stage III or IV (aOR: 3.23; 95% CI: 1.52-8.85; p=0.002). Neither Quintero stage nor sFGR were associated with infant survival. Conclusions: Intertwin differences in UA pulsatility index supersede the Quintero classification in the prediction of double infant survival following laser surgery in TTTS cases.