Outcome of twin–twin transfusion syndrome complicated by selective fetal growth restriction: systematic review and meta‐analysis

This systematic review aimed to compare the outcomes of monochorionic twin pregnancies undergoing laser surgery for twin-twin transfusion syndrome (TTTS) with and without the presence of selective fetal growth restriction (sFGR). The review included six studies involving 1710 pregnancies. The primary outcome was overall fetal loss after laser surgery. The results showed that pregnancies complicated by TTTS with sFGR had a higher risk of fetal loss compared to those without sFGR. However, this increased risk was observed mainly in the donor twin and not the recipient twin. The survival rate at birth was slightly lower in pregnancies with TTTS and sFGR compared to those without sFGR. There was no significant difference in the risk of preterm birth, composite perinatal morbidity, or respiratory morbidity between the two groups. However, the risk of neurologic morbidity was higher in the donor twin with TTTS and sFGR. Survival free from neurological impairment did not differ significantly between the groups. The findings suggest that sFGR complicating TTTS increases the risk of fetal loss following laser surgery, and this information can help in counseling parents and assessing individualized risks in these pregnancies.