Improved recipient survival with maternal nifedipine in twin-twin transfusion syndrome complicated by TTTS cardiomyopathy undergoing selective fetoscopic laser photocoagulation.

Abstract

OBJECTIVE:

The purpose of this study was to evaluate the effect of maternal nifedipine on fetal survival when started 24-48 hours before selective fetoscopic laser photocoagulation (SFLP).

STUDY DESIGN:

We conducted a case control study of consecutive cases of twin-twin transfusion syndrome (TTTS) in which TTTS cardiomyopathy was treated with maternal nifedipine 24-48 hours before SFLP, compared with gestational age and stage-matched control cases. The primary outcome was recipient and donor survival.

RESULTS:

One hundred forty-one cases of TTTS were treated with nifedipine, and 152 gestational age- and stage-matched control cases were analyzed. There was a significant increase in overall fetal survival in nifedipine-treated cases compared with control cases (237/284 [83%] vs 232/308 [75%]; P = .015). There is an increase in survival of recipients who were treated with nifedipine in stage IIIA (100% vs 81%; P = .021) and IIIB (93% vs 71%; P = .014); however, there was no difference in donor survival.

CONCLUSION:

Maternal nifedipine is associated with improved recipient survival in TTTS that undergoes SFLP. This is the first study to suggest a benefit of adjunctive maternal medical therapy in patients with TTTS who undergo SFLP.

• Authors: Timothy M Crombleholme, Foong-Yen Lim, Mounira Habli, William Polzin, Ronald Jaekle, Erik Michelfelder, James Cnota, Chunyan Liu, Mi-Ok Kim
• Journal: American journal of obstetrics and gynecology (Am J Obstet Gynecol) Vol. 203 Issue 4 Pg. 397.e1-9 (Oct 2010) ISSN: 1097-6868 [Electronic] United States
• PMID: 20723877 (Publication Type: Journal Article)
• Copyright: Copyright © 2010 Mosby, Inc. All rights reserved.

Chemical References

• Vasodilator Agents
• Nifedipine

Topics

• Cardiomyopathies (diagnosis, drug therapy)
• Case-Control Studies
• Female
• Fetofetal Transfusion (mortality, surgery)
• Fetoscopy
• Humans
• Laser Coagulation
• Nifedipine (therapeutic use)
• Pregnancy
• Severity of Illness Index
• Survival Analysis
• Ultrasonography, Prenatal
• Vasodilator Agents (therapeutic use)