TY - JOUR
T1 - Pregnancy outcomes following early fetoscopic laser photocoagulation for twin-to-twin transfusion syndrome at 16 weeks’ gestation
AU - Seaman, Rachel D.
AU - Salmanian, Bahram
AU - Shamshirsaz, Alireza A.
AU - Espinoza, Jimmy
AU - Sanz-Cortes, Magdalena
AU - Donepudi, Roopali
AU - Johnson, Rebecca
AU - Krispin, Eyal
AU - Sun, Raphael
AU - Belfort, Michael A.
AU - Nassr, Ahmed A.
N1 - Publisher Copyright:
© 2022
PY - 2023/1
Y1 - 2023/1
N2 - BACKGROUND: Ample evidence supports fetoscopic laser photocoagulation of placental anastomoses as a first-line treatment for twin-to-twin transfusion syndrome, but little is known about the outcomes following procedures conducted in the early second trimester. OBJECTIVE: This study aimed to evaluate perinatal outcomes following early fetoscopic laser placental photocoagulation performed for twin-to-twin transfusion syndrome at 16 weeks’ gestation. STUDY DESIGN: This retrospective review included monochorionic twin pregnancies complicated by twin-to-twin transfusion syndrome necessitating fetoscopic laser photocoagulation at a single tertiary center from 2012 to 2021. The 2 cohorts were defined as cases undergoing laser surgery at 16+0/7 to 16+6/7 weeks’ gestation (early laser group) and those undergoing laser surgery ≥17 weeks’ gestation (standard laser group), respectively. Primary outcomes included rates of immediate chorioamniotic membrane separation, preterm premature rupture of membranes, and clinical chorioamnionitis. Secondary outcomes included twin survival rates at birth and 30 days of life. Outcomes were compared between cohorts with a P value of <.05 denoting statistical significance. RESULTS: A total of 343 cases were included (35 early laser participants and 308 standard laser participants). The early laser group typically had higher Quintero staging at the time of the procedure. Following intervention, the early laser group had significantly higher rates of chorioamniotic separation than the standard laser group (34.3% vs 1.3% of cases; P<.001) and higher rates of preterm prelabor rupture of membranes (45.7% vs 25.0%; P=.009) and chorioamnionitis (11.4% vs 1.3%; P=.005). Even after adjustment for higher Quintero staging in the early laser group, twin survival was not significantly different between study groups. CONCLUSION: Early laser surgery for twin-to-twin transfusion syndrome performed at 16 weeks’ gestation is associated with significantly higher rates of chorioamniotic separation, preterm rupture of membranes, and chorioamnionitis. However, twin survival does not seem to be negatively impacted following early laser surgery.
AB - BACKGROUND: Ample evidence supports fetoscopic laser photocoagulation of placental anastomoses as a first-line treatment for twin-to-twin transfusion syndrome, but little is known about the outcomes following procedures conducted in the early second trimester. OBJECTIVE: This study aimed to evaluate perinatal outcomes following early fetoscopic laser placental photocoagulation performed for twin-to-twin transfusion syndrome at 16 weeks’ gestation. STUDY DESIGN: This retrospective review included monochorionic twin pregnancies complicated by twin-to-twin transfusion syndrome necessitating fetoscopic laser photocoagulation at a single tertiary center from 2012 to 2021. The 2 cohorts were defined as cases undergoing laser surgery at 16+0/7 to 16+6/7 weeks’ gestation (early laser group) and those undergoing laser surgery ≥17 weeks’ gestation (standard laser group), respectively. Primary outcomes included rates of immediate chorioamniotic membrane separation, preterm premature rupture of membranes, and clinical chorioamnionitis. Secondary outcomes included twin survival rates at birth and 30 days of life. Outcomes were compared between cohorts with a P value of <.05 denoting statistical significance. RESULTS: A total of 343 cases were included (35 early laser participants and 308 standard laser participants). The early laser group typically had higher Quintero staging at the time of the procedure. Following intervention, the early laser group had significantly higher rates of chorioamniotic separation than the standard laser group (34.3% vs 1.3% of cases; P<.001) and higher rates of preterm prelabor rupture of membranes (45.7% vs 25.0%; P=.009) and chorioamnionitis (11.4% vs 1.3%; P=.005). Even after adjustment for higher Quintero staging in the early laser group, twin survival was not significantly different between study groups. CONCLUSION: Early laser surgery for twin-to-twin transfusion syndrome performed at 16 weeks’ gestation is associated with significantly higher rates of chorioamniotic separation, preterm rupture of membranes, and chorioamnionitis. However, twin survival does not seem to be negatively impacted following early laser surgery.
KW - early gestation
KW - fetal intervention
KW - fetoscopic surgery
KW - laser photocoagulation
KW - monochorionic pregnancy
KW - second trimester
KW - twin pregnancy
KW - twin-to-twin transfusion syndrome
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U2 - 10.1016/j.ajogmf.2022.100771
DO - 10.1016/j.ajogmf.2022.100771
M3 - Article
C2 - 36244623
AN - SCOPUS:85141492910
SN - 2589-9333
VL - 5
JO - American Journal of Obstetrics and Gynecology MFM
JF - American Journal of Obstetrics and Gynecology MFM
IS - 1
M1 - 100771
ER -