Preterm delivery after fetoscopic laser surgery for twin–twin transfusion syndrome: etiology and risk factors

Malshe, Amol; Snowise, Saul; Mann, Lovepreet K.; Boring, Noemi; Johnson, Anthony; Bebbington, Michael; Moise, Kenneth J.; Papanna, Ramesha

doi:10.1002/uog.15972

Cited by 41 publications

(41 citation statements)

References 26 publications

(31 reference statements)

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“…To further study this high-risk subset of patients, we propose a future study comparing serial qfFN levels in TTTS patients with and without a cerclage. In addition, the current study did not demonstrate preoperative cervical length to be a significant risk factor for preterm birth, However, prior larger studies have demonstrated preoperative cervical length to be an important predictor of preterm birth after laser surgery for TTTS 2,4,24 . For instance, thresholds such as a preoperative cervical length <20 mm 2 or <28 mm 24 have been associated with an increased risk spontaneous preterm birth after laser surgery.…”

Section: Discussioncontrasting

confidence: 87%

Quantitative fetal fibronectin to predict spontaneous preterm delivery after laser surgery for twin-twin transfusion syndrome

Chon

Chan

Korst³

et al. 2019

Sci Rep

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Our goal was to assess whether quantitative fetal fibronectin (qfFN) is associated with spontaneous preterm birth (sPTB) after laser surgery for twin-twin transfusion syndrome (TTTS). qfFN was collected within 24 hours before and after laser surgery. Aims were: (1) To determine if qfFN changed with operative fetoscopy; and (2) To estimate the number of patients needed to study the predictive value of qfFN for sPTB <28 and <32 weeks. Results are reported as median (range). Among 49 patients, there was no net difference in qfFN levels after laser surgery [0.0 ng/mL (−37 to +400), p = 0.6041]. However, patients with a qfFN increase >10 ng/mL were 19 times more likely to undergo sPTB at <28 weeks (OR = 19.5). We determined that 383 and 160 patients would be needed to achieve adequate statistical power for qfFN to be predictive of sPTB at a GA <28 weeks and <32 weeks, respectively. In conclusion, laser surgery did not alter the qfFN level within the entire cohort, but qfFN may be useful in identifying a subset of patients at increased risk of preterm delivery.

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Section: Discussioncontrasting

confidence: 87%

Quantitative fetal fibronectin to predict spontaneous preterm delivery after laser surgery for twin-twin transfusion syndrome

Chon

Chan

Korst³

et al. 2019

Sci Rep

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“…Two hundred and thirty studies were therefore deemed eligible after full‐text review. From these, all randomized trials ( n = 6) and the largest observational studies ( n = 94) were selected for analysis (Figure ). There were 13 case–control studies, 32 prospective cohort studies and 49 retrospective cohort studies.…”

Section: Resultsmentioning

confidence: 99%

Outcome reporting across randomized trials and observational studies evaluating treatments for twin–twin transfusion syndrome: systematic review

Perry

Duffy

Umadia

et al. 2018

Ultrasound in Obstet & Gyne

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“…The fact that TTTS infants are still born prematurely is mostly due to PPROM after laser surgery. Iatrogenic PPROM occurs in up to 30% of cases [50,51]. Maternal complications of laser surgery are also not consistently reported, but appear to occur in about 5% of cases and include abdominal pain after leakage of amniotic fluid into the peritoneal cavity, chorioamnionitis, bleeding, pulmonary edema and placental abruption [45].…”

Section: Complications Of Fetoscopic Laser Surgerymentioning

confidence: 99%

Twin-twin transfusion syndrome in the era of fetoscopic laser surgery: antenatal management, neonatal outcome and beyond

Spruijt

Lopriore

Steggerda

et al. 2020

Expert Review of Hematology

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Introduction: Twin-twin transfusion syndrome (TTTS) is a devastating complication of monochorionic twin pregnancy and remains a major challenge for worldwide fetal medicine specialists. In TTTS, intertwin transfusion through vascular anastomoses in the shared placenta leads to severe hemodynamic imbalance. This review summarizes the current knowledge of TTTS. Areas covered: The most recent insights concerning the management of TTTS, as well as fetal and neonatal complications are described. Relevant articles were selected based on a Pubmed search using the keywords below. Understanding of the underlying pathophysiology has improved greatly as a result of placental injection studies. Advancements in antenatal management have led to increased perinatal survival and a decreased incidence of neonatal complications, including brain injury and neurodevelopmental impairment. Expert opinion: Further opportunities for improvement comprise technological innovations in laser procedures and the prevention of preterm rupture of membranes with subsequent prematurity. A noninvasive treatment such as high-intensity focused ultrasound (HIFU) seems to hold promise for the future treatment of TTTS. Fetal MRI studies are important to improve our understanding of fetal brain injury and should relate their findings to long-term neurodevelopment. International collaboration and centralization of care are of paramount importance to ensure the best care for our patients.

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Preterm delivery after fetoscopic laser surgery for twin–twin transfusion syndrome: etiology and risk factors

Cited by 41 publications

References 26 publications

Quantitative fetal fibronectin to predict spontaneous preterm delivery after laser surgery for twin-twin transfusion syndrome

Quantitative fetal fibronectin to predict spontaneous preterm delivery after laser surgery for twin-twin transfusion syndrome

Outcome reporting across randomized trials and observational studies evaluating treatments for twin–twin transfusion syndrome: systematic review

Twin-twin transfusion syndrome in the era of fetoscopic laser surgery: antenatal management, neonatal outcome and beyond

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