Early laser surgery is not associated with very preterm delivery or reduced neonatal survival in TTTS

• DOI: 10.1002/uog.22190
• Publication Date: 2020-08-31T04:24:46Z
• Authors: J. Espinoza; M. A. Belfort; A. A. Shamshirsaz; A. A. Nassr; M. Sanz Cortes; R. Donepudi; A. F. Espinoza; T. G. Ostovar‐Ker...; R. Johnson; C. Harman; O. Turan
• Keywords: Adult; Fetal Membranes, Premature Rupture; Fetoscopy; Pregnancy Outcome; Gestational Age; Fetofetal Transfusion; Middle Aged; Survival Analysis; Texas; 3. Good health; Cohort Studies; Young Adult; 03 medical and health sciences; 0302 clinical medicine; Pregnancy; Pregnancy, Twin; Humans; Premature Birth; Female; Laser Therapy; Retrospective Studies

To evaluate the association of laser photocoagulation placental anastomoses (LPA) prior to 18 weeks' gestation (early LPA) with very preterm delivery and neonatal survival in pregnancies twin-twin transfusion syndrome (TTTS).This was a retrospective cohort study monochorionic diamniotic twin TTTS undergoing LPA between 2002 2018 at two institutions. The rates < 28, 30 32 gestation, prelabor rupture membranes (PPROM) 30-day one or both infants were compared early those ≥ gestation. Regression analysis performed determine survival, adjusted for Quintero stage, phase, selective fetal growth restriction, gestational age delivery, maternal 35 years, body mass index > kg/m2 , location, use Seldinger method place operative trocar, size participating center, Solomon technique, cerclage PPROM. Survival using Cox proportional hazard model applied examine LPA-to-delivery interval according timing surgery, confounding variables.A total 414 included study, which 68 (16.4%) underwent LPA. In cohort, incidence 22.7%, 39.6% 53.4%, respectively. twins least days 67.5% 90.8%, No significant difference noted that had weeks rate 28 (19.1% vs 23.4%; P = 0.4), (38.2% 39.9%; 0.8) (44.1% 55.2%; 0.1) PPROM (29.0% 24.1%; double-twin (63.9% 68.1%; 0.5) infant (91.8% 90.6%; 0.7) days. Early not associated regression analyses. longer (median, 106.9 (range, 2-164 days) median, 69.3 0-146 days); 0.001) when variables (hazard ratio, 2.56 (95% CI, 1.76-3.73); 0.001).Laser surgery before is an increased reduced after weeks. © 2020 International Society Ultrasound Obstetrics Gynecology.