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Evolution of Stage 1 Twin-to-Twin Transfusion Syndrome (TTTS): Systematic Review and Meta-Analysis

  • Asma Khalil (a1), Emily Cooper (a1), Rosemary Townsend (a1) and Basky Thilaganathan (a1)

Abstract

Objectives: The natural history of stage 1 Twin-to-twin transfusion syndrome (TTTS) remains unclear and its optimal management is yet to be established. The main aims of this meta-analysis were to quantify the incidence of progression in stage 1 TTTS and to ascertain survival in these pregnancies.

Methods: MEDLINE, EMBASE, and The Cochrane Library were searched. Reference lists within each article were hand-searched for additional reports. The outcomes included incidence of progression and survival in stage 1 TTTS. Randomized controlled trials, cohort and case-control studies were included. Case reports, studies including three or fewer cases of stage 1 TTTS, and editorials were excluded. Proportion meta-analysis was used for analysis (Registration number: CRD42016036190).

Results: The search yielded 3,085 citations; 18 studies were included in the review (172 pregnancies to assess progression and 433 pregnancies to assess the survival). The pooled incidence of progression in stage 1 TTTS was 27% [95% CI 16–39%]. The pooled overall survival, double survival and at least one survival in the pregnancies managed expectantly were 79% [95% CI 62–92%], 70% [95% CI 54–84%] and 87% [95% CI 69–98%], respectively. In those undergoing amnioreduction, the corresponding figures were 77% [95% CI 68–85%], 67% [95% CI 57–76%] and 86% [95% CI 76–94%], respectively. The survival rates were 68% [95% CI 54–81%], 54% [95% CI 36–72%], and 81% [95% CI 69–90%], when laser surgery was performed.

Conclusions: The optimal initial management of stage 1 TTTS remains in equipoise. The ongoing randomized trial comparing immediate laser surgery versus conservative management should provide a definitive answer.

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Corresponding author

address for correspondence: Dr Asma Khalil, Fetal Medicine Unit, St George's University of London, Cranmer Terrace, London SW17 0RE, UK. E-mail: asmakhalil79@googlemail.com

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Evolution of Stage 1 Twin-to-Twin Transfusion Syndrome (TTTS): Systematic Review and Meta-Analysis

  • Asma Khalil (a1), Emily Cooper (a1), Rosemary Townsend (a1) and Basky Thilaganathan (a1)

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