A Cohort Analysis of Patients with Stage I Twin-to-Twin Transfusion Syndrome from a Major Referral Hospital in Northern China

Objective:To describe the outcomes of StageⅠtwin-to-twin transfusion syndrome among patients treated with expectant management(EM),amnioreduction(AR),or fetoscopic laser occlusion of chorioangiopagous vessels(FLOC).Methods:A cohort of 89 cases was studied.Based on the initial management strategy,patients were classified into three groups:the EM,AR,and FLOC.We assessed perinatal survival to 28 days of age and categorized pregnancy outcomes as good(twin live birth at≥30.0 weeks),mixed(single fetal demise or delivery between 26.0 and 29.9 weeks),or poor(double fetal demise or delivery at<26.0 weeks).Results:26(29.2%)patients underwent EM,35(39.3%)underwent AR,and 28(31.5%)underwent FLOC therapy.Of those managed expectantly,19.2%experienced spontaneous abortion,50%progressed in stage,and 30.8%remained stable or regressed.After adjusting for potential confounders including maternal age,'null'iparity,placenta location,and recipient maximum vertical pocket,and so on,FLOC therapy and AR were associated with significantly[odds ratio(OR)=0.09]and borderline significantly(OR=0.20)reduced risks of poor pregnancy outcomes and of no survivors to 28 days of age after birth(OR=0.04 and OR=0.20,respectively)compared with EM.Conclusion:About 70%of those treated with EM progressed in stage or experienced fetal loss.Compared to EM,intervention may decrease the risk of poor pregnancy outcomes and improve the perinatal survival rate.