Amer J Perinatol 2018; 35(04): 317-323
DOI: 10.1055/s-0037-1615795
SMFM Fellowship Series Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Polyhydramnios Affecting a Recipient-like Twin: Risk of Progression to Twin–Twin Transfusion Syndrome and Outcomes

Erin E. Washburn
1  Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California
,
Teresa N. Sparks
1  Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California
,
Kristen A. Gosnell
2  Fetal Treatment Center, University of California, San Francisco, California
,
Larry Rand
1  Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California
2  Fetal Treatment Center, University of California, San Francisco, California
,
Juan M. Gonzalez
1  Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California
2  Fetal Treatment Center, University of California, San Francisco, California
,
Vickie A. Feldstein
1  Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California
2  Fetal Treatment Center, University of California, San Francisco, California
3  Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
› Author Affiliations
Funding None.
Further Information

Publication History

11 April 2017

15 November 2017

Publication Date:
29 December 2017 (eFirst)

Abstract

Objective The significance of polyhydramnios of one twin in the absence of oligohydramnios of the cotwin in monochorionic diamniotic (MCDA) twin pregnancies (polyhydramnios affecting a recipient-like twin [PART]) is unknown. Our aim is to assess the risk of progression to twin–twin transfusion syndrome (TTTS) with PART, progression to ≥ stage II TTTS, and neonatal survival.

Study Design This study was a retrospective cohort study of MCDA twin pregnancies with PART evaluated at a referral center from 2008 to 2015.

Results Sixty-four MCDA twin pregnancies with PART were identified. Fifteen (23.4%) progressed to TTTS, including 10 (15.6%) who progressed to ≥ stage II TTTS. Three pregnancies were terminated and one underwent selective reduction by radiofrequency ablation. Overall survival was 113 out of 128 (88.3%). Of those who remained stable, 91.8% (N = 45) had survival of both neonates. In multivariate analysis, the presence of arterioarterial (A-A) anastomosis by in utero Doppler ultrasound was associated with decreased risk of progression to TTTS (odds ratio: 0.12, p = 0.03, 95% confidence interval: 0.02–0.78).

Conclusion Most MCDA twin pregnancies with PART do not progress to TTTS and have a favorable prognosis. Progression rates are higher than observed in uncomplicated MCDA twins; however, so close surveillance is warranted. The presence of an A-A anastomosis appears to confer decreased risk of progression to TTTS.

Note

This study was presented at the 36th Annual Pregnancy Meeting of the Society for Maternal-Fetal Medicine in Atlanta, GA, February 1–6, 2016.