Delivery timing after laser surgery for twin-twin transfusion syndrome

Objective: To compare outcomes of twin-twin transfusion syndrome (TTTS) patients who underwent early elective delivery vs. expectant management. Study design: Retrospective study of monochorionic diamniotic twins who underwent laser surgery for TTTS and had dual survivors at 32 weeks. Patients who underwent elective delivery between 32 0/7 to 35 6/7 weeks (“early elective group”) were compared with all patients who delivered ≥36 0/7 weeks (“expectant management group”). The primary outcome was a composite of fetal and neonatal morbidity. Results: The final study population was comprised of 15 early elective and 119 expectant management patients. Those in the early elective group were seven times more likely to experience the primary outcome (OR 7.38 [2.01–27.13], p = 0.0026). Conclusion: Among patients who underwent laser surgery for TTTS who had dual survivors at 32 weeks, elective delivery prior to 36 weeks did not appear to be protective.