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Intertwin differences in umbilical artery PI supersede the TTTS Quintero classification in the prediction of infant survival: a retrospective cohort study
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  • 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

Corresponding Author:[email protected]

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Michael Belfort (FETAL MEDICINE ISSUE EDITOR)
Baylor College of Medicine
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Alireza Shamshirsaz
Baylor College of Medicine
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Ahmed Nassr
Baylor College of Medicine
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Magdalena Sanz Cortes
BAYLOR COLLEGE OF MEDICINE, TEXAS
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Roopali Donepudi
Baylor College of Medicine and Texas Childrens Hospital Pavilion for Women, Houston, TX, United States
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Andres Espinoza
Baylor College of Medicine and Texas Childrens Hospital Pavilion for Women, Houston, TX, United States
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Tiffany Ostovar-Kermani
Baylor College of Medicine and Texas Childrens Hospital Pavilion for Women, Houston, TX, United States
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Rebecca Johnson
BCM
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Christopher Harman
University of Maryland School of Medicine
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Halis Ozdemir
University of Maryland School of Medicine
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Ozhan Turan
University of Maryland School of Medicine
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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.