{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T05:38:26Z","timestamp":1791437906898,"version":"4.3.3"},"reference-count":18,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2021,7,9]],"date-time":"2021-07-09T00:00:00Z","timestamp":1625788800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To compare the perinatal outcome of monochorionic twin pregnancies with twin\u2013twin transfusion syndrome (TTTS), according to the disease severity, defined using Quintero staging, after treatment with fetoscopic laser surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a single\u2010center study of 1020 consecutive cases with severe TTTS, which were treated with fetoscopic laser surgery. During the study period from January 1995 to March 2013, the participants were included at a mean\u2009\u00b1\u2009SD gestational age of 20.8\u2009\u00b1\u20092.2\u2009weeks. Perinatal survival analysis, including the rates of double survival and survival of at least one fetus, was undertaken according to the Quintero staging system. For blockwise comparisons of data, the whole population was divided into five chronologically consecutive study subgroups of 200 patients in each of the first four subgroups and 220 in the last one.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>For the entire study population with known outcome (<jats:italic>n<\/jats:italic>\u2009=\u20091019), the rate of pregnancy with double fetal survival was 69.0% (127\/184) in Stage\u2010I, 71.4% (257\/360) in Stage\u2010II, 55.4% (236\/426) in Stage\u2010III and 51.0% (25\/49) in Stage\u2010IV TTTS cases. At least one twin survived in 91.3% (168\/184) of pregnancies with Stage\u2010I, 89.7% (323\/360) of those with Stage\u2010II, 83.1% (354\/426) of those with Stage\u2010III and 77.6% (38\/49) of those with Stage\u2010IV TTTS. The rates of double survival and survival of at least one fetus were both significantly higher in Stage\u2010II TTTS compared with those in Stage\u2010III TTTS cases (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001 and <jats:italic>P<\/jats:italic>\u2009=\u20090.011, respectively). Survival rates between pregnancies with Stage\u2010I <jats:italic>vs<\/jats:italic> Stage\u2010II TTTS and between those with Stage\u2010III <jats:italic>vs<\/jats:italic> Stage\u2010IV TTTS were not significantly different. Therefore, we combined pregnancies with Stage\u2010I or Stage\u2010II TTTS, and those with Stage\u2010III or Stage\u2010IV TTTS. The double survival rate was 70.6% (384\/544) in combined Stage\u2010I and Stage\u2010II <jats:italic>vs<\/jats:italic> 54.9% (261\/475) in combined Stage\u2010III and Stage\u2010IV TTTS cases (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). At least one twin survived in 90.3% (491\/544) of pregnancies with Stage\u2010I or Stage\u2010II TTTS <jats:italic>vs<\/jats:italic> 82.5% (392\/475) in those with Stage\u2010III or Stage\u2010IV TTTS (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). The double survival rate increased between the first and the last consecutive study subgroups from 59.8% (55\/92) to 75.0% (96\/128) (adjusted odds ratio (aOR)<jats:sub>linear trend<\/jats:sub>, 1.26 (95%\u2009CI, 1.01\u20131.56); <jats:italic>P<\/jats:italic>\u2009=\u20090.037) in pregnancies with Stage\u2010I or Stage\u2010II TTTS and from 41.7% (45\/108) to 62.0% (57\/92) (aOR<jats:sub>linear trend<\/jats:sub>, 1.21 (95%\u2009CI, 0.98\u20131.50); <jats:italic>P<\/jats:italic>\u2009=\u20090.082) in those with Stage\u2010III or Stage\u2010IV TTTS. Double survival rate was the lowest for Stage\u2010III cases in which the donor twin was affected by severely abnormal Doppler findings (45.4% (64\/141)).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Double survival and survival of at least one fetus in monochorionic twin pregnancies with TTTS were related significantly to Quintero stage. However, our data show that the differentiation between Stages I <jats:italic>vs<\/jats:italic> II and Stages III <jats:italic>vs<\/jats:italic> IV does not have any significant prognostic implication for perinatal survival. \u00a9 2020 The Authors. Ultrasound in Obstetrics &amp; Gynecology published by John Wiley &amp; Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.23131","type":"journal-article","created":{"date-parts":[[2020,9,22]],"date-time":"2020-09-22T11:50:39Z","timestamp":1600775439000},"page":"201-206","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Differentiation between TTTS Stages I <i>vs<\/i> II and III <i>vs<\/i> IV does not affect probability of double survival after laser therapy"],"prefix":"10.1002","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8135-0453","authenticated-orcid":false,"given":"C.","family":"Bamberg","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Fetal Medicine University Medical Centre Hamburg\u2010Eppendorf  Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W.","family":"Diehl","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Fetal Medicine University Medical Centre Hamburg\u2010Eppendorf  Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2546-5464","authenticated-orcid":false,"given":"A.","family":"Diemert","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Fetal Medicine University Medical Centre Hamburg\u2010Eppendorf  Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Sehner","sequence":"additional","affiliation":[{"name":"Department of Medical Biometry and Epidemiology University Medical Centre Hamburg\u2010Eppendorf  Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3172-1164","authenticated-orcid":false,"given":"K.","family":"Hecher","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Fetal Medicine University Medical Centre Hamburg\u2010Eppendorf  Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,7,9]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.17520"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1159\/000437053"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.jp.7200292"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2009.12.006"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa032597"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000225945.17022.6b"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1159\/000362385"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1159\/000098715"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2010.02680.x"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1479-828X.2008.00942.x"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2003.292"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2011.02.001"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tjog.2015.05.006"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0029-1215430"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1159\/000076716"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.5221"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.5218"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)62419-8"}],"container-title":["Ultrasound in Obstetrics &amp; Gynecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.23131","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/uog.23131","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.23131","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,28]],"date-time":"2023-08-28T03:58:40Z","timestamp":1693195120000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/uog.23131"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,9]]},"references-count":18,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2021,8]]}},"alternative-id":["10.1002\/uog.23131"],"URL":"https:\/\/doi.org\/10.1002\/uog.23131","archive":["Portico"],"relation":{},"ISSN":["0960-7692","1469-0705"],"issn-type":[{"value":"0960-7692","type":"print"},{"value":"1469-0705","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,9]]},"assertion":[{"value":"2020-04-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-09-11","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-07-09","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}