{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T21:10:58Z","timestamp":1788469858256,"version":"build-2803163510"},"reference-count":39,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2024,9,2]],"date-time":"2024-09-02T00:00:00Z","timestamp":1725235200000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100014016","name":"Kelly Family Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100014016","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate twin survival stratified by Quintero stage in patients with twin\u2010to\u2010twin transfusion syndrome (TTTS) after Solomon laser treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a single\u2010center study at Johns Hopkins Center for Fetal Therapy, investigating a cohort of consecutive twin pregnancies treated with the Solomon laser technique for TTTS. Preoperative Quintero stage, perioperative characteristics and obstetric factors were investigated in relation to neonatal survival of the recipient and donor twins at discharge. Determinants of twin survival were evaluated using univariate logistic regression and cumulative survival probability analyses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 402 pregnancies with TTTS that underwent Solomon laser treatment, 80 (19.9%) were diagnosed with Quintero Stage\u2010I TTTS, 126 (31.3%) with Stage II, 169 (42.0%) with Stage III and 27 (6.7%) with Stage IV. Post\u2010laser twin anemia polycythemia sequence or recurrent TTTS occurred in 19 (4.7%) patients and 11 (2.7%) required repeat laser surgery. Preterm prelabor rupture of membranes occurred in 150 (37.3%) patients and median gestational age at delivery was 32\u2009+\u20091\u2009weeks. In 303 (75.4%) patients, both twins were alive at discharge; 67\/80 (83.8%) were Stage I, 101\/126 (80.2%) were Stage II, 113\/169 (66.9%) were Stage III and 22\/27 (81.5%) were Stage IV (<jats:italic>P<\/jats:italic>\u2009=\u20090.062). Donor twin survival was  lower than that of recipients in cases with Stage\u2010III TTTS (118\/169 (69.8%) <jats:italic>vs<\/jats:italic> 145\/169 (85.8%) (<jats:italic>\u03c7<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u200926.076, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.0001)). Higher intertwin size discordance and absent or reversed umbilical artery (UA) end\u2010diastolic velocity (EDV) were associated with donor demise (Nagelkerke <jats:italic>R<\/jats:italic><jats:sup>2<\/jats:sup>, 0.38; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). Overall, spontaneous post\u2010laser donor demise occurred in 53 (39.6%) patients, accounting for the majority of all losses. Cumulative donor survival decreased from 92% to 65% when intertwin size discordance was &gt;30% and to 48% when UA\u2010EDV was absent or reversed (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The Solomon laser technique achieves TTTS resolution and double twin survival in a high proportion of cases. Recipient and donor survival is comparable unless there is significant intertwin size discordance and placental dysfunction. This degree of unequal placental sharing, typically found in Stage\u2010III TTTS, is the primary factor preventing double survival due to a higher rate of donor demise. \u00a9 2024 International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.27620","type":"journal-article","created":{"date-parts":[[2024,2,21]],"date-time":"2024-02-21T08:20:12Z","timestamp":1708503612000},"page":"314-321","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Stage\u2010based recipient and donor outcome in twin\u2010to\u2010twin transfusion syndrome treated by fetoscopic laser surgery using Solomon technique"],"prefix":"10.1002","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8721-5818","authenticated-orcid":false,"given":"I.","family":"Kyvernitakis","sequence":"first","affiliation":[{"name":"Section for Prenatal Diagnosis and Fetal Therapy, Asklepios Klinik Barmbek, Asklepios Medical School University of Semmelweis  Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5239-699X","authenticated-orcid":false,"given":"M.","family":"Rosner","sequence":"additional","affiliation":[{"name":"Johns Hopkins Center for Fetal Therapy, Department of Gynecology &amp; Obstetrics Johns Hopkins University School of Medicine  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Birk","sequence":"additional","affiliation":[{"name":"Johns Hopkins Center for Fetal Therapy, Department of Gynecology &amp; Obstetrics Johns Hopkins University School of Medicine  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Goodman","sequence":"additional","affiliation":[{"name":"Johns Hopkins Center for Fetal Therapy, Department of Gynecology &amp; Obstetrics Johns Hopkins University School of Medicine  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Herlands","sequence":"additional","affiliation":[{"name":"Johns Hopkins Center for Fetal Therapy, Department of Gynecology &amp; Obstetrics Johns Hopkins University School of Medicine  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Wohlmuth","sequence":"additional","affiliation":[{"name":"Section for Prenatal Diagnosis and Fetal Therapy, Asklepios Klinik Barmbek, Asklepios Medical School University of Semmelweis  Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Laurie","sequence":"additional","affiliation":[{"name":"Johns Hopkins Center for Fetal Therapy, Department of Gynecology &amp; Obstetrics Johns Hopkins University School of Medicine  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Millard","sequence":"additional","affiliation":[{"name":"Johns Hopkins Center for Fetal Therapy, Department of Gynecology &amp; Obstetrics Johns Hopkins University School of Medicine  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Kush","sequence":"additional","affiliation":[{"name":"Johns Hopkins Center for Fetal Therapy, Department of Gynecology &amp; Obstetrics Johns Hopkins University School of Medicine  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0189-8265","authenticated-orcid":false,"given":"J.","family":"Miller","sequence":"additional","affiliation":[{"name":"Johns Hopkins Center for Fetal Therapy, Department of Gynecology &amp; Obstetrics Johns Hopkins University School of Medicine  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1927-2084","authenticated-orcid":false,"given":"A. 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