Fetus-Placenta-Newborn
Obstetric and perinatal outcomes from The Australian and New Zealand Twin-Twin Transfusion Syndrome Registry*

https://doi.org/10.1067/mob.2000.104236Get rights and content

Abstract

Objective: Our purpose was to investigate the antepartum characteristics and perinatal outcomes of twin-twin transfusion syndrome cases from a multicenter national registry. Study Design: Perinatal centers in Australia and New Zealand voluntarily notified a central evaluation registry with information on identified pregnancies with twin-twin transfusion syndrome during 1995 through 1998. Results: One hundred twelve cases of twin-twin transfusion syndrome were registered. The median gestation at diagnosis was 21.5 weeks (range, 14.4-34.6 weeks). Oligohydramnios-polyhydramnios sequence was the most common presentation, with 84% of cases involving “stuck” twinning. Therapeutic amnioreduction was used in 92 cases (82.1%), with the median number of procedures per case being 2 (range, 1-23). The median gestation at delivery was 29 weeks (range, 18-38 weeks). The overall perinatal survival rate was 62.5%. Abnormal findings on cranial ultrasonography were present in 27.3% of live neonates, and periventricular leukomalacia was reported in 10.8%. Increased gestational age at delivery, the presence of umbilical artery diastolic flow, and a prolonged interval from final amnioreduction to delivery were positively associated with the delivery of live fetuses without complications. Conclusion: The majority of antenatally identified cases of twin-twin transfusion syndrome are managed with serial amnioreduction. Despite contemporary obstetric and neonatal management strategies, perinatal mortality and morbidity rates are high. (Am J Obstet Gynecol 2000;182:706-12.)

Section snippets

Material and methods

In 1995 a national twin-twin transfusion syndrome registry was established in Australia and New Zealand, with the central registry location at the Women and Infants Research Foundation, Perth, Western Australia. The principal aim of the registry was to assess contemporary management strategies and outcomes in prenatally identified cases of twin-twin transfusion syndrome. All tertiary obstetric hospitals in Australia and New Zealand were contacted regarding the registry, and their participation

Results

During the 3-year period from November 1995 to November 1998, a total of 112 cases of twin-twin transfusion syndrome were reported to the national registry from 13 centers within Australia and New Zealand. These centers represented the majority of tertiary obstetric units in Australia and the largest tertiary obstetric unit in New Zealand. The principal criterion used for diagnosis was a severe discrepancy in amniotic fluid volumes in twin gestations known or thought to have monochorionic

Comment

Our national registry of cases of twin-twin transfusion syndrome clearly demonstrates this condition to have significant perinatal mortality and morbidity rates, even with accepted contemporary management strategies. Because the condition is uncommon, most centers would have limited experience in the management of twin-twin transfusion syndrome and compilation of large numbers from a single center would be difficult. This registry, operating for 3 years, has received information on 112 cases of

Acknowledgements

Participating centers and Principal Investigators: Mater Mothers Hospital, Queensland (Dr Robert Cincotta); National Women’s Hospital, New Zealand (Dr Alistair Roberts); Westmead Hospital, New South Wales (Dr Brian Trudinger); King George V Hospital, New South Wales (Dr Fergus Scott); Liverpool Hospital, New South Wales (Dr John Smoliniec); John Hunter Hospital, New South Wales (Dr Warwick Giles); Woden Valley Hospital, Australian Capital Territory (Dr Michael Peek); Royal Women’s Hospital,

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*

Reprint requests: Jan E. Dickinson, FRANZCOG, King Edward Memorial Hospital for Women, 374 Bagot Road, Subiaco, Western Australia 6008, Australia.

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