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Twin–Twin Transfusion Syndrome: A Population-Based Study

Samawal Lutfi, MD, CABP^*, Victoria M. Allen, MD, FRCSC, John Fahey, MMath, Colleen M. O'Connell, PhD and Michael J. Vincer, MD, FRCPC^*

From the Neonatal Pediatrics Division, Department of Obstetrics and Gynaecology, Reproductive Care Program of Nova Scotia, and Perinatal Epidemiology Research Unit, IWK Health Centre, Halifax, Nova Scotia, Canada.

Address reprint requests to: Samawal Lutfi, MD, CABP, Neonatal Pediatrics Division, IWK Health Centre, 5980 University Avenue, Halifax, NS, B3J 3G9; e-mail: samawal_lutfi{at}yahoo.com.

OBJECTIVE: To study the incidence and mortality and morbidity rates of twin–twin transfusion syndrome in a complete population-based cohort in Nova Scotia.

METHODS: A population-based cohort study of all monochorionic diamniotic twin pregnancies of 20 weeks of gestation or longer born to Nova Scotia (Canada) residents between 1988 and 2000 was examined. The effect of gestational age adjustment and birth weight discordancy of more than 20% on mortality and 1-year survival was studied. Other outcomes studied included birth depression, respiratory distress syndrome, chronic lung disease, interventricular hemorrhage, periventricular leukomalacia, acute renal failure, and congestive heart failure.

RESULTS: Of 404 monochorionic-diamniotic twin pregnancies examined, 48 were identified with twin–twin transfusion syndrome. Total mortality rates per pregnancy were significantly greater in the twin–twin transfusion syndrome group than in the remainder of our monochorionic diamniotic population (P < .01). However, when adjusted for gestational age, mortality failed to achieve statistical significance. Similarly, no differences were noted for 1-year survival and other outcomes of liveborn infants after gestational age adjustment. Discordance in birth weight predicted a higher incidence of morbid outcomes per pregnancy, but this effect was lost after gestational age adjustment.

CONCLUSION: Increased morbidity and mortality of twins with twin–twin transfusion syndrome is likely to be due to a higher incidence of preterm birth. Birth weight discordancy was not found to be an independent predictor of mortality after controlling for gestational age and twin-twin transfusion syndrome.

LEVEL OF EVIDENCE: II-2