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The relationship between preoperative fetal head circumference and 2-year cognitive performance after laser surgery

Andrew H Chon1, Mary Rose Mamey2, Sheree M Schrager2

  • 1Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.

Prenatal Diagnosis
|January 10, 2018
PubMed

Insights

Larger fetal head circumference before laser surgery for twin-twin transfusion syndrome (TTTS) is linked to better cognitive outcomes in children. Smaller head circumferences may indicate a risk for lower, though normal, cognitive scores.

Area of Science:

  • Perinatology
  • Developmental Pediatrics
  • Neonatal Surgery

Background:

  • Twin-twin transfusion syndrome (TTTS) is a serious complication of monochorionic twin pregnancies.
  • Laser surgery is a common treatment for TTTS, but neurodevelopmental outcomes require further investigation.
  • Fetal head circumference (HC) is a key indicator of fetal growth and development.

Purpose of the Study:

  • To investigate the association between preoperative fetal head circumference (HC) and cognitive performance in children treated for TTTS.
  • To assess the impact of laser surgery on HC growth discordance between donor and recipient twins.

Main Methods:

  • Ninety-nine children treated for TTTS underwent cognitive assessment using the Battelle Developmental Inventory Second Edition (BDI-2) at 2 years corrected age.
  • Preoperative fetal HC measurements (16-26 weeks gestation) and HC at 2 years were analyzed.
  • Multilevel multivariate regression models and repeated-measures ANOVA were used to analyze data.

Main Results:

  • A larger preoperative HC percentile was significantly associated with higher total BDI-2 scores (P < 0.001).
  • A 12.5% increase in preoperative HC percentile correlated with a 1-point increase in total BDI-2 score.
  • The HC percentile difference between donor and recipient twins decreased post-laser surgery.

Conclusions:

  • Preoperative fetal HC percentile is a predictor of cognitive performance in children treated for TTTS.
  • Smaller preoperative HC percentiles identify children at risk for lower, but still within the normal range, cognitive scores.
  • Laser surgery effectively reduces HC discordance between TTTS-affected twins.
Abstract

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