Twin and Cotwin Predictors of Fetal Demise After Laser Photocoagulation Therapy in Advanced Stage Twin-Twin Transfusion Syndrome: A Fetal Heart Society Research Collaborative Study

Authors

• Shiraz A Maskatia
• Fu-Sheng Chou
• Betul Yilmaz
• Lisa Howley
• Vidhya Annavajjhala
• Lindsay Freud
• Allison Divanovic
• Laxmi Ghimire
• Anita J Moon-Grady

Language

English

Publication Date

1-6-2026

Journal

Journal of the American Heart Association

DOI

10.1161/JAHA.125.045070

PMID

41432013

PMCID

PMC12909029

PubMedCentral® Posted Date

12-3-2025

PubMedCentral® Full Text Version

Post-print

Abstract

Background: Current models to predict outcomes in advanced twin-twin transfusion syndrome are limited. We hypothesized that twin and cotwin echocardiographic factors would improve model performance for donor and recipient demise following laser photocoagulation therapy.

Methods: We performed a multicenter retrospective cohort study of stage 3 to 4 twin-twin transfusion syndrome referred for laser photocoagulation therapy. Fetal echocardiograms were analyzed at a core laboratory. We used multivariable logistic regression models to select variables used for generalized linear mixed-effects modeling. Separate models were developed for donor and recipient demise, using both twin and cotwin variables. Models were assessed by area under the receiver operating characteristic curves.

Results: Laser photocoagulation therapy was performed in 285 twin gestations at 20.2±2.8 weeks. Donor demise (32%) occurred more frequently than recipient demise (15%; P< 0.001). Final model variables for donor demise were donor fetal weight, nifedipine administration, umbilical arterial and venous flow patterns, donor cardiac output, left ventricular myocardial performance index, recipient deepest vertical pocket, recipient chest/thoracic ratio, recipient cardiac output, and recipient ductus venosus flow pattern; and for recipient demise were nifedipine use, recipient combined cardiac output, recipient left ventricular myocardial performance index, recipient umbilical arterial flow pattern, and donor left ventricular myocardial performance index. Including cotwin variables in models for donor and recipient demise improved performance. Final model area under the receiver operating characteristic curves were 0.82 for both donor and recipient demise.

Conclusions: This is the largest multicenter study to rigorously evaluate echocardiographic metrics associated with fetal demise in twin-twin transfusion syndrome and the first to identify intertwin parameters associated with cotwin demise.

Keywords

Humans, Fetofetal Transfusion, Female, Pregnancy, Retrospective Studies, Laser Coagulation, Ultrasonography, Prenatal, Fetal Death, Echocardiography, Fetal Heart, Gestational Age, Adult, Treatment Outcome, Risk Factors, Predictive Value of Tests, cardiac output, echocardiography, fetal, laser therapy, maternal–fetal medicine, myocardial performance index, twin–twin transfusion syndrome

Published Open-Access

yes

Recommended Citation

Maskatia, Shiraz A; Chou, Fu-Sheng; Yilmaz, Betul; et al., "Twin and Cotwin Predictors of Fetal Demise After Laser Photocoagulation Therapy in Advanced Stage Twin-Twin Transfusion Syndrome: A Fetal Heart Society Research Collaborative Study" (2026). Faculty, Staff and Student Publications. 4135.
https://digitalcommons.library.tmc.edu/uthmed_docs/4135