Outcomes of stage I TTTS or liquor discordant twins: a single‐centre review

Hinch, E.; Henry, Amanda; Wilson, Isabella; Welsh, A.W.

doi:10.1002/pd.4814

Cited by 4 publications

(7 citation statements)

References 25 publications

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“…These 26 studies included 2699 MCDA twin pregnancies affected by TTTS. Gestational age at diagnosis of TTTS was reported only by 10 studies 28,30,32,33,38,39,41,46,48,52 Of the pregnancies with Stage-I TTTS in which treatment type was known, 62.4% (285/457) were treated with laser therapy, 13.1% (60/457) were treated with amnioreduction and 24.5% (112/457) were managed expectantly.…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

“…Seventeen studies [28][29][30][31][32][33]35,[37][38][39][40]42,46,48,[51][52][53] Figure S1a). PTB before Figure 3).…”

Section: Stage-i Tttsmentioning

confidence: 99%

“…There was no survival of either twin in 15.0% (95% CI, 9.9-20.9%) (76/590) of pregnancies, while one and two survivors were reported in 22 (Table S2). 28 Barbosa (2018) 29 Duryea (2016) 30 Chang (2016) 31 Hinch (2016) 32 Emery (2016) 33 Eschbach (2016) 34 Has (2014) 35 Ruano (2013) 36 Swiatkowska-Freund (2012) 37 Chmait (2011) 38 Bebbington (2010) 39 Fichera (2010) 40 Korpraphong (2010) 41 Meriki (2010) 42 Morris (2010) 43 Cincotta (2009) 44 Ruano (2009) 45 Wagner (2009) 46 Middeldorp (2007) 47 O'Donoghue (2007) 48 Sepulveda (2007) 49 Gray (2006) 50 Huber (2006) 51 Duncombe (2003) 52 Quintero (2003) 53 Only first author's name given for each study. Study can be awarded maximum of one star for each numbered item within selection and outcome categories.…”

Section: Stage-ii Tttsmentioning

confidence: 99%

“…Characteristics of included studies reporting outcome of twin-twin transfusion syndrome according to Quintero stage and before 32 weeks' gestation complicated 50.0% (95% CI, 12.6-98.7%) (1/2) and 27.1% (95% CI, 13.9-42.8%) (9/34) of pregnancies with Stage-I TTTS, respectively, while there was no case of PTB before 28 weeks among those included(Table S2).Three studies reported data on neonatal morbidity in pregnancies complicated by Stage-I TTTS32,46,53 . Composite morbidity was reported in 22.9% (95% CI, 0.1-68.5%) (44/188) of twins, and neurological and respiratory morbidity complicated 1.5% (95% CI, 0.02-5.1%) (2/148) and 19.1% (95% CI, 11.3-29.1%) (16/84) of twins after birth, respectively(Table S3).When stratifying the analysis of pregnancies with Stage-I TTTS according to the different management options (expectant management, laser therapy or amnioreduction) the mean gestational age at diagnosis was 21.0, 21.4 and 23.5 weeks, respectively(Table S4).…”

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confidence: 99%

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Outcome of twin–twin transfusion syndrome according to Quintero stage of disease: systematic review and meta‐analysis

Mascio

Khalil

D’Amico

et al. 2020

Ultrasound in Obstet & Gyne

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Objectives To report the outcome of pregnancies complicated by twin–twin transfusion syndrome (TTTS) according to Quintero stage. Methods MEDLINE, EMBASE and CINAHL databases were searched for studies reporting the outcome of pregnancies complicated by TTTS stratified according to Quintero stage (I–V). The primary outcome was fetal survival rate according to Quintero stage. Secondary outcomes were gestational age at birth, preterm birth (PTB) before 34, 32 and 28 weeks' gestation and neonatal morbidity. Outcomes are reported according to the different management options (expectant management, laser therapy or amnioreduction) for pregnancies with Stage‐I TTTS. Only cases treated with laser therapy were considered for those with Stages‐II–IV TTTS and only cases managed expectantly were considered for those with Stage‐V TTTS. Random‐effects head‐to‐head meta‐analysis was used to analyze the extracted data. Results Twenty‐six studies (2699 twin pregnancies) were included. Overall, 610 (22.6%) pregnancies were diagnosed with Quintero stage‐I TTTS, 692 (25.6%) were Stage II, 1146 (42.5%) were Stage III, 247 (9.2%) were Stage IV and four (0.1%) were Stage V. Survival of at least one twin occurred in 86.9% (95% CI, 84.0–89.7%) (456/552) of pregnancies with Stage‐I, in 85% (95% CI, 79.1–90.1%) (514/590) of those with Stage‐II, in 81.5% (95% CI, 76.6–86.0%) (875/1040) of those with Stage‐III, in 82.8% (95% CI, 73.6–90.4%) (172/205) of those with Stage‐IV and in 54.6% (95% CI, 24.8–82.6%) (5/9) of those with Stage‐V TTTS. The rate of a pregnancy with no survivor was 11.8% (95% CI, 8.4–15.8%) (69/564) in those with Stage‐I, 15.0% (95% CI, 9.9–20.9%) (76/590) in those with Stage‐II, 18.6% (95% CI, 14.2–23.4%) (165/1040) in those with Stage‐III, 17.2% (95% CI, 9.6–26.4%) (33/205) in those with Stage‐IV and in 45.4% (95% CI, 17.4–75.2%) (4/9) in those with Stage‐V TTTS. Gestational age at birth was similar in pregnancies with Stages‐I–III TTTS, and gradually decreased in those with Stages‐IV and ‐V TTTS. Overall, the incidence of PTB and neonatal morbidity increased as the severity of TTTS increased, but data on these two outcomes were limited by the small sample size of the included studies. When stratifying the analysis of pregnancies with Stage‐I TTTS according to the type of intervention, the rate of fetal survival of at least one twin was 84.9% (95% CI, 70.4–95.1%) (94/112) in cases managed expectantly, 86.7% (95% CI, 82.6–90.4%) (249/285) in those undergoing laser therapy and 92.2% (95% CI, 84.2–97.6%) (56/60) in those after amnioreduction, while the rate of double survival was 67.9% (95% CI, 57.0–77.9%) (73/108), 69.7% (95% CI, 61.6–77.1%) (203/285) and 80.8% (95% CI, 62.0–94.2%) (49/60), respectively. Conclusions Overall survival in monochorionic diamniotic pregnancies affected by TTTS is higher for earlier Quintero stages (I and II), but fetal survival rates are moderately high even in those with Stage‐III or ‐IV TTTS when treated with laser therapy. Gestational age at birth was similar in pregnancies with Sta...

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Section: Study Selection and Characteristicsmentioning

confidence: 99%

“…Seventeen studies [28][29][30][31][32][33]35,[37][38][39][40]42,46,48,[51][52][53] Figure S1a). PTB before Figure 3).…”

Section: Stage-i Tttsmentioning

confidence: 99%

Section: Stage-ii Tttsmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Outcome of twin–twin transfusion syndrome according to Quintero stage of disease: systematic review and meta‐analysis

Mascio

Khalil

D’Amico

et al. 2020

Ultrasound in Obstet & Gyne

View full text Add to dashboard Cite

show abstract

“…Moreover, the natural history of stage 1 TTTS was not well defined, and some studies showed high rates of disease regression or stabilization, thereby supporting conservative management. Two studies published in 2016 complicated the field even further: An Australian report on 43 cases of stage 1 TTTS shows that the disease can remain stable or regress in up to 59% of cases, suggesting that conservative management would be an acceptable option. On the other hand, the North Atlantic Fetal Therapy Network (Naftnet) showed in a retrospective cohort of 124 cases that 60% progress and that fetoscopic laser ablation of the placental vascular anastomoses has the potential to reduce adverse outcomes.…”

Section: Advances In Invasive Fetal Therapymentioning

confidence: 99%