Midtrimester isolated polyhydramnios in monochorionic diamniotic multiple gestations.

Abstract

OBJECTIVE:

To identify risk factors for development of twin-twin transfusion syndrome (TTTS) in monochorionic diamniotic multiple gestations complicated by midtrimester isolated polyhydramnios (iPoly).

STUDY DESIGN:

A retrospective study of patients referred for possible TTTS between 16 and 26 gestational weeks was performed. IPoly was defined as a maximum vertical pocket of ≥8 cm in the iPoly twin's sac and >2 and <8 cm in the co-twin's sac on the consultative ultrasound.

RESULTS:

Of 628 consecutive patients referred for possible TTTS, 74 were diagnosed with iPoly. The majority of these patients (n = 52, 70.3%) were not subsequently diagnosed with TTTS, and of these, 40 were managed expectantly and 12 had amnioreductions because of symptomatic iPoly; 30-day perinatal survival of at-least-one twin in the non-TTTS group was 93.0% (40/43). TTTS developed in the 22 remaining patients, of which 63.6% were of advanced Quintero Stage. Nineteen underwent laser surgery; 30-day perinatal survival of at-least-one twin was 84.2% (16/19). In a multivariate logistic regression model, 2 characteristics were associated with the development of TTTS: (1) gestational age <20 weeks at the time of diagnosis of iPoly (odds ratio, 13.48; 95% confidence interval, 3.40-53.48; P = .0002); and (2) intrauterine growth restriction of the co-twin (odds ratio, 7.28; 95% confidence interval, 1.72-30.88; P = .0071).

CONCLUSION:

Among referred patients with midtrimester iPoly, 29.7% subsequently developed TTTS. Early diagnosis (<20 weeks) and/or co-twin intrauterine growth restriction were significant risk factors for development of TTTS in these patients.

• Authors: Andrew H Chon, Lisa M Korst, Arlyn Llanes, David A Miller, Joseph G Ouzounian, Ramen H Chmait
• Journal: American journal of obstetrics and gynecology (Am J Obstet Gynecol) Vol. 211 Issue 3 Pg. 303.e1-5 (Sep 2014) ISSN: 1097-6868 [Electronic] United States
• PMID: 24858201 (Publication Type: Journal Article)
• Copyright: Copyright © 2014 Mosby, Inc. All rights reserved.

Topics

• Adolescent
• Adult
• Female
• Fetofetal Transfusion (etiology)
• Humans
• Logistic Models
• Middle Aged
• Polyhydramnios (diagnosis)
• Pregnancy
• Pregnancy Trimester, Second
• Pregnancy, Multiple
• Retrospective Studies
• Twins, Monozygotic