{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T16:51:58Z","timestamp":1791564718355,"version":"4.3.4"},"reference-count":43,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,2,15]],"date-time":"2026-02-15T00:00:00Z","timestamp":1771113600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,15]],"date-time":"2026-02-15T00:00:00Z","timestamp":1771113600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Data on early\u2010onset twin\u2010to\u2010twin transfusion syndrome (TTTS) are scarce and, therefore, evidence\u2010based counseling and management of these pregnancies are challenging. This study aimed to investigate survival rates and establish predictors of survival after fetoscopic laser surgery (FLS) for early\u2010onset TTTS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was an international multicenter retrospective cohort study of monochorionic diamniotic twin pregnancies complicated by TTTS diagnosed before 18\u2009+\u20090\u2009weeks' gestation that underwent FLS. The primary outcome was dual\u2010twin survival at 28\u2009days after birth. Secondary outcomes included survival of at least one twin and dual\u2010twin demise at 28\u2009days after birth. Monoamniotic twin, triplet and higher\u2010order multiple pregnancies, pregnancies with chromosomal or structural fetal anomaly and TTTS cases not treated by FLS were excluded. Pre\u2010, intra\u2010 and postoperative characteristics were analyzed using multivariable logistic regression analysis. Discriminative performance was assessed using receiver\u2010operating\u2010characteristics\u2010curve analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 485 cases of early\u2010onset TTTS that underwent FLS were included. The rates of dual\u2010twin survival and survival of at least one twin at 28\u2009days after birth were 51.5% (250\/485) and 76.7% (372\/485), respectively, while 23.3% (113\/485) of cases resulted in dual\u2010twin demise. Multivariable logistic regression analysis showed that absent or reversed end\u2010diastolic flow (AREDF) in the donor umbilical artery (adjusted odds ratio (aOR), 0.487 (95%\u2009CI, 0.273\u20130.867)) and absent or reversed a\u2010wave in the donor ductus venosus (aOR, 0.299 (95%\u2009CI, 0.110\u20130.810)) at the time of TTTS diagnosis were associated independently with decreased odds of dual\u2010twin survival, while higher gestational age at birth was associated with increased odds of both dual\u2010twin survival (aOR, 1.172 (95%\u2009CI, 1.117\u20131.229)) and survival of at least one twin (aOR, 2.053 (95%\u2009CI, 1.699\u20132.481)). The model for dual\u2010twin survival showed modest discriminative performance with poor overall fit.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      The presence of AREDF in the donor umbilical artery and absent or reversed a\u2010wave in the donor ductus venosus, at the time of diagnosis of TTTS, and lower gestational age at birth were independent adverse predictors for dual\u2010twin survival following FLS in cases of TTTS diagnosed before 18\u2009weeks. Future studies should explore the impact of surgical technique on survival rates. \u00a9 2026 The Author(s).\n                      <jats:italic>Ultrasound in Obstetrics &amp; Gynecology<\/jats:italic>\n                      published by John Wiley &amp; Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/uog.70178","type":"journal-article","created":{"date-parts":[[2026,2,15]],"date-time":"2026-02-15T17:15:26Z","timestamp":1771175726000},"page":"295-303","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prediction of survival after fetoscopic laser surgery for early\u2010onset twin\u2010to\u2010twin transfusion syndrome"],"prefix":"10.1002","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2329-4470","authenticated-orcid":false,"given":"S.","family":"Prasad","sequence":"first","affiliation":[{"name":"Fetal Medicine Unit, St George's Hospitals NHS Foundation Trust University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7380-0576","authenticated-orcid":false,"given":"F. G.","family":"Sileo","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit, St George's Hospitals NHS Foundation Trust University of London  London UK"},{"name":"Prenatal Medicine Unit University of Modena and Reggio Emilia  Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5725-9270","authenticated-orcid":false,"given":"J.","family":"Binder","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Feto\u2010Maternal Medicine Medical University of Vienna  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Brunelli","sequence":"additional","affiliation":[{"name":"Obstetric Unit, Department of Medical and Surgical Sciences University of Bologna and IRCCS Azienda Ospedaliero\u2212Universitaria S. Orsola\u2212Malpighi  Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Chianchiano","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit, Bucchieri La Ferla\u2010Fatebenefratelli Hospital  Palermo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1966-0466","authenticated-orcid":false,"given":"C. M.","family":"Coutinho","sequence":"additional","affiliation":[{"name":"Hospital das Cl\u00ednicas da Faculdade de Medicina de Ribeir\u00e3o Preto, Universidade de S\u00e3o Paulo  Ribeir\u00e3o Preto Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"D'Antonio","sequence":"additional","affiliation":[{"name":"Center for Fetal Care and High\u2010Risk Pregnancy, Department of Obstetrics and Gynecology University \u2018G. d'Annunzio\u2019 of Chieti\u2212Pescara  Chieti Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"D\u00f6bert","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Fetal Medicine University Medical Center Hamburg\u2212Eppendorf  Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Fichera","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Sciences University of Brescia  Brescia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Y.","family":"Gielchinsky","sequence":"additional","affiliation":[{"name":"Fetal Medicine Center, Helen Schneider Hospital for Women, Rabin Medical Center  Petach Tikvah Israel"},{"name":"Faculty of Medical and Health Sciences Tel Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Hecher","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Fetal Medicine University Medical Center Hamburg\u2212Eppendorf  Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Iacovella","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Buergerhospital \u2212 Dr. Senckenbergische Stiftung  Frankfurt am Main Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Malone","sequence":"additional","affiliation":[{"name":"Department of Maternal\u2212Fetal Medicine Royal Women's Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7600-4281","authenticated-orcid":false,"given":"A.","family":"Martinez\u2010Varea","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology La Fe University and Polytechnic Hospital  Valencia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. N.","family":"N\u00f8rgaard","sequence":"additional","affiliation":[{"name":"Center of Fetal Medicine, Department of Obstetrics Copenhagen University Hospital  Rigshospitalet, Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8801-5677","authenticated-orcid":false,"given":"C.","family":"Rodo","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Reproductive Medicine Maternal\u2212Fetal Medicine Unit, Grup de Recerca en Medicina Materna i Fetal, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"Sim\u00f5es","sequence":"additional","affiliation":[{"name":"Department of Maternal\u2212Fetal Medicine, Alfredo da Costa Maternity Hospital Nova Medical School  Lisbon Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3952-0313","authenticated-orcid":false,"given":"F.","family":"Slaghekke","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Feto\u2010Maternal Medicine Leiden University Medical Center  Leiden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0702-370X","authenticated-orcid":false,"given":"Y.","family":"Yinon","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Faculty of Medical and Health Sciences Tel Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2802-7670","authenticated-orcid":false,"given":"A.","family":"Khalil","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit, St George's Hospitals NHS Foundation Trust University of London  London UK"},{"name":"Vascular Biology Research Centre Molecular and Clinical Sciences Research Institute, St George's University of London  London UK"},{"name":"Fetal Medicine Unit Liverpool Women's Hospital  Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Collaborators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,15]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1159\/000313300"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-4642(18)30127-5"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa032597"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2022.08.001"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.29166"},{"key":"e_1_2_6_7_1","unstructured":"Overview|Twin and triplet pregnancy|Guidance|NICE. 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