Pregnancy outcomes following early fetoscopic laser photocoagulation for twin-to-twin transfusion syndrome at 16 weeks’ gestation

Seaman, Rachel D.; Salmanian, Bahram; Shamshirsaz, Alireza A.; Espinoza, Jimmy; Sanz-Cortés, Magdalena; Donepudi, Roopali; Johnson, R.C.; Krispin, Eyal; Sun, Raphael C.; Belfort, Michael A.; Nassr, Ahmed A.

doi:10.1016/j.ajogmf.2022.100771

Cited by 2 publications

(8 citation statements)

References 20 publications

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“…Title and abstract screening resulted in 61 potentially eligible studies. After a full‐text assessment was performed, nine studies encompassing 1691 TTTS pregnancies were included 20,21,23,28–33 . Study characteristics are presented in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…In the subgroup analysis of TTTS cases who had undergone FLS at <16 weeks compared with those who had FLS between 16 and 18 weeks, perinatal mortality rates did not differ (Table 3). A recent study on perinatal outcomes following FLS at <16 weeks of pregnancy showed an association between early FLS and significantly higher rates of chorioamniotic separation, PPROM and chorioamnionitis, but no negative impact on survival 21 …”

Section: Discussionmentioning

confidence: 96%

“…A recent study on perinatal outcomes following FLS at <16 weeks of pregnancy showed an association between early FLS and significantly higher rates of chorioamniotic separation, PPROM and chorioamnionitis, but no negative impact on survival. 21 The strengths of this review are the thorough search and assessment of three large databases. We acknowledge the limitations of our study.…”

Section: Authormentioning

confidence: 99%

“…A systematic review from 2020 showed that twin pregnancies affected by early twin‐to‐twin transfusion syndrome are at substantial risk of perinatal mortality and morbidity; however, data at that time came from very small case series with no head‐to‐head comparisons 19 . Few larger studies have been published since that last review providing data on outcomes for early TTTS 20–23 . Knowing that there is still no consensus on the optimal management for early TTTS, we aimed to provide an updated systematic review and meta‐analysis of pregnancy characteristics and outcomes in TTTS with FLS at <18 weeks vs ≥18 weeks and to perform a subgroup analysis for those at <16 weeks vs 16–18 weeks.…”

Section: Introductionmentioning

confidence: 99%

“… 19 Few larger studies have been published since that last review providing data on outcomes for early TTTS. 20 , 21 , 22 , 23 Knowing that there is still no consensus on the optimal management for early TTTS, we aimed to provide an updated systematic review and meta‐analysis of pregnancy characteristics and outcomes in TTTS with FLS at <18 weeks vs ≥18 weeks and to perform a subgroup analysis for those at <16 weeks vs 16–18 weeks.…”

Section: Introductionmentioning

confidence: 99%

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Perinatal outcomes following fetoscopic laser surgery for early twin‐to‐twin transfusion syndrome: Systematic review and meta‐analysis

Mustafa,

Aghajani,

Patrick

et al. 2024

Acta Obstet Gynecol Scand

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IntroductionOur objective was to investigate outcomes in twin‐to‐twin transfusion syndrome (TTTS) treated with fetoscopic laser surgery (FLS) at <18 weeks vs ≥18 weeks, and to conduct subgroup analysis of TTTS with FLS at <16 weeks vs 16–18 weeks.Material and methodsPubMed, Scopus and Web of Science were searched systematically from inception until May 2023. Primary outcome was survival, and secondary outcomes included preterm premature rupture of membranes (PPROM), preterm birth and gestational age (GA) at delivery.ResultsNine studies encompassing 1691 TTTS pregnancies were included. TTTS stage III was significantly more common in TTTS pregnancies treated with FLS at <18 weeks (odds ratio [OR] 2.84, 95% confidence interval [CI] 1.24–6.54), and procedure duration was shorter at <18 weeks (MD −5.27 minutes, 95% CI −9.19 to −1.34). GA at delivery was significantly earlier in TTTS pregnancies treated with FLS at <18 weeks (MD −3.12 weeks, 95% CI −6.11 to −0.13). There were no significant differences in outcomes, including PPROM, PPROM at <7 days post‐FLS, preterm birth at <28 and <32 weeks, delivery at <7 days post‐FLS, and survival outcomes, including fetal demise, live birth and neonatal survival. Similarly, TTTS stage III was more common in TTTS with FLS at <16 weeks than at 16–18 weeks (OR 2.95, 95% CI 1.62–5.35), with no significant differences in the aforementioned outcomes.ConclusionsIn early TTTS treated with FLS, outcomes were comparable between those treated at <18 weeks compared with ≥18 weeks except for GA at delivery, which was 3 weeks earlier. In the subset treated at <16 weeks vs 16–18 weeks, the procedure was feasible without an increased risk of very early preterm birth or perinatal mortality.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 96%

Section: Authormentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Perinatal outcomes following fetoscopic laser surgery for early twin‐to‐twin transfusion syndrome: Systematic review and meta‐analysis

Mustafa,

Aghajani,

Patrick

et al. 2024

Acta Obstet Gynecol Scand

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Effect of Gestational Age at Fetoscopic Laser Photocoagulation on Perinatal Outcomes for Patients with Twin–Twin Transfusion Syndrome

Chiu

Chang

Chao

et al. 2023

JCM

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Purpose: The aim of this study was to evaluate the effect of gestational age (GA) at the time of fetoscopic laser photocoagulation (FLP) for severe twin–twin transfusion syndrome (TTTS) on perinatal outcomes in a single center in Taiwan. Materials and methods: Severe TTTS was defined as a diagnosis of TTTS before a GA of 26 weeks. Consecutive cases of severe TTTS treated at our hospital with FLP between October 2005 and September 2022 were included. The evaluated perinatal outcomes were preterm premature rupture of membranes (PPROM) within 21 days of FLP, survival 28 days after delivery, GA at delivery, and neonatal brain sonographic imaging findings within 1 month of delivery. Results: We included 197 severe TTTS cases; the mean GA at the time of FLP was 20.6 weeks. After the cases were divided into cases of FLP at early (below 20 weeks) and late GAs (more than 20 weeks), the early-GA group was discovered to be associated with a deeper maximum vertical pocket in the recipient twin, a higher rate of PPROM development within 21 days of FLP, and lower rates of survival of one or both twins. In the cases of stage I TTTS, the rate of PPROM within 21 days of FLP was higher in the group that underwent FLP at an early GA than in the group that underwent FLP at a late GA (50% (3/6) vs. 0% (0/24), respectively, p = 0.005). Logistic regression analysis revealed that the GA at the time of FLP and the cervical length before FLP is implemented are significantly associated with the survival of one twin and the incidence of PPROM development within 21 days of FLP. The GA at the time of FLP, the cervical length before FLP, and TTTS being stage III TTTS were associated with the survival of both twins after FLP. Neonatal brain image anomalies were associated with GA at delivery. Conclusions: FLP being performed at an earlier GA is a risk factor for lower fetal survival and PPROM development within 21 days of FLP in cases of severe TTTS. Delaying FLP for cases involving stage I TTTS diagnosed at an early GA without risk factors, such as maternal symptoms, cardiac overload in the recipient twin, or a short cervical length, may be considered, but whether delaying FLP would improve surgical outcomes and, if so, how long the delay should be may need further trials to answer.

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Pregnancy outcomes following early fetoscopic laser photocoagulation for twin-to-twin transfusion syndrome at 16 weeks’ gestation

Cited by 2 publications

References 20 publications

Perinatal outcomes following fetoscopic laser surgery for early twin‐to‐twin transfusion syndrome: Systematic review and meta‐analysis

Perinatal outcomes following fetoscopic laser surgery for early twin‐to‐twin transfusion syndrome: Systematic review and meta‐analysis

Effect of Gestational Age at Fetoscopic Laser Photocoagulation on Perinatal Outcomes for Patients with Twin–Twin Transfusion Syndrome

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