Background Approximately half of twin-to-twin transfusion syndrome (TTTS) cases are complicated by selective fetal growth restriction (sFGR). Although fetoscopic laser photocoagulation (FLP) is the standard treatment, perinatal outcomes in cases with concomitant sFGR—particularly according to single or dual fetal survival after laser—are not well established. Objective To compare post-FLP obstetrical and neonatal outcomes between TTTS+sFGR and isolated TTTS, with separate analyses in pregnancies with immediate single or dual fetal survival. Design This was a retrospective cohort study including all TTTS cases treated with FLP at a single institution between November 2011 and April 2023. TTTS was diagnosed according to Quintero criteria. Outcomes included immediate post-FLP fetal demise (48-hour after FLP), preterm premature rupture of membranes (PPROM), gestational age (GA) at delivery, and neonatal survival, according to post-FLP single or dual fetal survival. Results Among 424 cases, 188 (44.3%) had TTTS+sFGR. Gestational age and cervical length at FLP were similar between groups, but TTTS+sFGR cases showed more severe disease, with a higher proportion of Quintero stage III. Dual fetal survival after FLP was lower in TTTS+sFGR compared with iTTTS (79.6% vs. 88.5%). In pregnancies with single fetal survival post-FLP, TTTS+sFGR was associated with higher rates of delivery before 32 weeks (p=0.03) and increased post-FLP PPROM (p=0.03). Ex-donor fetuses in this group had significantly lower survival at birth and at 30 days compared with iTTTS. In cases with dual survival post-FLP, ex-donor survival at birth and at 30 days remained lower in TTTS+sFGR, while no other perinatal outcomes differed. Conclusion When stratified by immediate single or dual post-FLP survival, pregnancies with TTTS complicated by sFGR showed consistently worse obstetrical and neonatal outcomes compared with isolated TTTS, particularly due to reduced ex donor survival across both groups.
Benítez et al. (Thu,) studied this question.