Main Findings:
The results of our study demonstrate that intertwin differences in
umbilical artery impedance to blood prior to laser surgery supersede the
Quintero classification (or any of its sonographic criteria) in the
prediction of double infant survival in TTTS cases. These observations
are consistent with an earlier report indicating that intertwin DUAPI
<0.4 is associated with increased infant survival in TTTS
cases where both fetuses have positive end-diastolic flow in the
umbilical arteries (Quintero stages I and II) prior to laser
surgery9. This study further demonstrates that the
same applies to TTTS cases with Quintero stages III or IV when the
statistical analysis is adjusted for gestational age at delivery, sFGR,
and other important confounders.