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
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California
,
Teresa N. Sparks
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California
,
Kristen A. Gosnell
Fetal Treatment Center, University of California, San Francisco, California
,
Larry Rand
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California
Fetal Treatment Center, University of California, San Francisco, California
,
Juan M. Gonzalez
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California
Fetal Treatment Center, University of California, San Francisco, California
,
Vickie A. Feldstein
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California
Fetal Treatment Center, University of California, San Francisco, California
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.