Fortnightly surveillance of monochorionic diamniotic twins for twin to twin transfusion syndrome: Compliance and effectiveness

Objectives To determine the compliance and effectiveness of fortnightly ultrasound surveillance for detection of twin‐twin transfusion syndrome (TTTS) in monochorionic diamniotic (MCDA) twin gestations. Methods This is a retrospective study of ultrasound surveillance of MCDA twins for TTTS. Our surv...

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Bibliographic Details
Published in:Prenatal diagnosis 2020-12, Vol.40 (12), p.1598-1605
Main Authors: Brock, Clifton O., Sibai, Baha M., Soto, Eleazar E., Moise, Kenneth J., Johnson, Anthony, Blackwell, Sean C., Hernandez Andrade, Edgar A., Papanna, Ramesha
Format: Article
Language:English
Subjects:
Abnormalities
Compliance
Fetuses
Gestational age
Surveillance
Transfusion
Twins
Ultrasonic imaging
Ultrasound
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Summary:Objectives To determine the compliance and effectiveness of fortnightly ultrasound surveillance for detection of twin‐twin transfusion syndrome (TTTS) in monochorionic diamniotic (MCDA) twin gestations. Methods This is a retrospective study of ultrasound surveillance of MCDA twins for TTTS. Our surveillance protocol requires fortnightly ultrasounds starting at 16 weeks of gestational age (GA) continuing until delivery. Compliance was assessed by determining the GA of surveillance initiation and time between ultrasounds. GA and Quintero Stage at diagnosis were evaluated to determine whether TTTS was detected prior to advanced disease (Quintero Stage III +) or fetal demise. Results Of 442 women, 264 (59.7%) initiated surveillance after 16 weeks; follow‐up ultrasounds were late in 17.4% of cases. TTTS was diagnosed in 43 (9.7%) women at a median GA of 19.7 [17.4, 23.9] weeks. Of 25/43 (58.1%) cases diagnosed during protocol compliance, 12 had advanced disease and two had fetal demise. A similar proportion of diagnoses (n = 18), made while non‐compliant, exhibited advanced disease (11/18, 61.1%, P = .40). Thirteen diagnoses occurred during periods of increased ultrasound frequency due to abnormalities (ie, fluid/estimated fetal weight discrepancies or Doppler abnormalities). Conclusions In this population, fortnightly ultrasound compliance was suboptimal. Advanced disease and fetal demise occurred during protocol compliance.
ISSN:0197-3851
1097-0223
DOI:10.1002/pd.5810