Conclusions
Collectively, our observations indicate that the estimation of intertwin differences in vascular impedance to umbilical artery blood supersedes the Quintero staging in the prediction of double infant survival in TTTS cases. DUAPI <0.4 is associated with a three-fold increase in double infant survival to 30 days of life in cases undergoing laser photocoagulation of placental anastomoses for the management of TTTS cases with Quintero stages I and II as well as in those with Quintero stages III and IV. Intertwin differences in the umbilical artery pulsatility index may provide novel metrics to evaluate the progression and severity of TTTS cases requiring laser surgery.
Disclosure of Interests and Contribution to Authorship:
We confirm that all authors including JE, MAB, AAS, AAS, MSC, RD, AFE,TGO, RMJ, CH, HO and OT have met the conditions of authorship.
We confirm that all authors including JE, MAB, AAS, AAS, MSC, RD, AFE,TGO, RMJ, CH, HO and OT declared no conflicts of interests with this manuscript.
Details of ethics approval: The study received approval from the Baylor College of Medicine Institutional Review Board and University Of Maryland School Of Medicine (H-19834, H-36458 and HP-00040715-12).
Funding: Baylor College of Medicine (BCM), internal funding
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