Evaluation of the CHOP cardiovascular score as a prognostic predictor of outcome in twin-twin transfusion syndrome after laser coagulation of placental vessels in a prospective cohort

Abstract

Objective To investigate the prognostic value of cardiacfunction assessment by the previously reported CHOP(Children's Hospital of Philadelphia) cardiovascular scorein twin-twin transfusion syndrome (TTTS). Methods All consecutive monochorionic pregnanciespresenting with TTTS over a 24-month period wereevaluated by preoperative echocardiography beforepercutaneous laser coagulation of chorionic vessels. Each of the 12 items of the CHOP score wasevaluated prospectively and the cardiovascular score wascategorized into stages using previously published cutoffs. The outcome considered for this study was neonatalsurvival of neither, one or both twins. Results In total, 215 pregnancies were enrolled. Due totechnical issues, CHOP evaluation was incomplete in16% of cases and follow-up was unavailable in 12%. Overall, there was a significant relationship betweenthe CHOP score and the Quintero staging system, although this relationship was significantly reducedwhen parameters used in the Quintero system wereremoved from the CHOP score. Based upon neonatalsurvival, the CHOP score did not show any prognosticvalue regarding overall pregnancy outcome or individualrecipient survival. Conclusion Cardiac function assessment using the CHOP score is not of clinical use as a prognostic markerin TTTS. This suggests that cardiac function may not beof interest for preoperative staging when laser coagulationis the first-line treatment, other than to confirm thediagnosis of TTTS requiring surgery. Copyright © 2010 ISUOG. Published by John Wiley & Sons, Ltd.