OP08.08: Predictors of single and double survival after laser ablation for early Twin–twin transfusion syndrome

Data on early Twin–twin transfusion syndrome (TTTS) is scarce, and therefore, individualised management and counselling of these pregnancies are limited. This study aimed to assess factors that are predictive of single and double survival after Laser surgery for early TTTS. This was an international multicentre cohort study of early TTTS (< 18 weeks) undergoing Laser surgery. The main study outcomes were single and double survival after laser surgery. Monoamniotic twins, triplets or higher order multiples and fetuses with chromosomal/structural anomalies, as well as TTTS cases not treated by Laser, were excluded. Baseline preoperative, intraoperative and postoperative characteristics were analysed using multivariable regression. The predictive accuracy was assessed using AUROC analysis. A total of 484 cases of early TTTS undergoing laser surgery were included in the analysis. Following multivariable regression analysis, coexisting selective fetal growth restriction (sFGR) showed significant and independent association (adjusted odds ratio [aOR] 0.52, 95% CI 0.30-0.91, p = 0.022, AUROC = 0.65) with double survival. sFGR (aOR 2.0, 95% CI 0.99-4.20, p = 0.05) and preterm premature rupture of membranes (PPROM) (aOR 4.12, 95% CI 1.91-9.13, p < 0.001) were independent predictors of single survival (AUROC 0.64). Following adjusting for potential confounders, placental location, Quintero stage, and technique of laser ablation (Solomon versus selective) were not significantly associated with either of the primary outcomes (p > 0.05 for all). Coexisting sFGR at the time of TTTS diagnosis and postoperative PPROM are independent predictors of survival following laser ablation for early TTTS. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.