Colorado Fetal Care Center 2017 Overview and Outcomes CIMFH_160133591_2017-07_CFCC 2017 Overview and Out | Page 10

2016 REPORT CONDITIONS - TTTS
Volumes and Outcomes Twin-to-Twin
Transfusion Syndrome
Under the leadership of fetal medicine pioneers, we continually strive to improve
the outlook for our unborn patients through integrated care, multidisciplinary
collaboration and dedicated research. We monitor and measure our outcomes
against the quality metrics of other nationally recognized programs, and we’re
proud of what we’ve achieved: consistently reporting some of the best outcomes
in the nation.
TTTS SURVIVAL BY COMPLICATION
2016 Volumes
We publish our volumes data through the North American Fetal Therapy Network (NAFTNet), a consortium of fetal
care centers in the U.S. and Canada dedicated to informing patients and advancing the field.
Diagnostic imaging procedures
CCAM
Complete anatomic surveys 4,338 Diagnosed 17
Fetal MRI 400 EXIT to resection 1
Fetal echocardiography 1,521 Congenital diaphragmatic hernia
Diagnostic procedures
Diagnosed
Genetic amniocentesis 132
Chorionic villus sampling 61
Fetal blood sampling 14
Amniotic band
Diagnosed
3
1
Structural congenital heart disease
(except isolated VSD or ASD)
Diagnosed
62
Diagnosed 34
Treated with open fetal surgery 22
Cesarean delivery 34
Sacrococcygeal teratoma
4
Twin-to-twin transfusion
Diagnosed 70
Treated with laser 53
Deliveries
Total
10
21
Myelomeningocele
Diagnosed
Fetal neck mass
Diagnosed
In 15 percent of pregnancies in which identical twins share a placenta,
the two fetuses get an unequal flow of blood. This condition, known
as twin-to-twin transfusion syndrome (TTTS), can cause serious
complications, potentially fatal to both twins. Timing is critical.
Outcomes vastly improve with early treatment, ideally within hours
of diagnosis. Our fetal surgeons are available for consultation and
treatment 24 hours a day, seven days a week.
176
Despite the
rarity of these
conditions we
tend to see
significantly
higher
volumes year
over year,
relative to
the rate of
occurrence
nationally.
SFLPs Performed 2012- April 2017
Pregnancies
All Pregnancies 209
Survival
of one or
more** Survival
of both** Double
Demise**
184
(88%) 140
(66.9%) 25
(12.0%)
*Complications include anterior placenta, selective IUGR, short cervix, and GA<18wks
**Calculated at pregnancy level
Advancing the field
Michael Zaretsky, MD, medical director of our Maternal Fetal Care Unit,
currently leads a study through NAFTNet to better understand when and
why mothers deliver after TTTS laser ablation. This work will clarify the
risks following the procedure and better prepare our team for the timing
of delivery.
88%
Survival of one or both
AMONG THE
FIRST
to use Nifedipine for TTTS
96.5%
Survival rate (of one or more) in 29 cases,
when no other complications were present.
Dr. Timothy Crombleholme pioneered the routine use of Nifedipine
to treat TTTS-associated cardiomyopathy, which is associated with
recipient survival.
Due to an increased rate of brain abnormalities in TTTS patients,
Dr. Mariana Meyers also offers prenatal MRI prior to fetal intervention,
an approach that has led us to identify associated anomalies in about
15 percent of TTTS cases. The data we obtain enables a better-informed
consideration of treatment options, and with it, better outcomes.
Colorado Fetal Care Center 2017
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