OBJECTIVE: To estimate the odds of severe cerebral injury and long-term neurodevelopmental impairment in monochorionic twins treated with amnioreduction versus laser surgery for twin-twin transfusion syndrome. METHODS: A systematic review and meta-analysis of studies on cerebral injury and long-term impairment after amnioreduction versus laser surgery were conducted. Odds ratios (OR) with their 95% confidence interval (CI) were computed. RESULTS: Electronic and manual search identified 63 references. Five studies were included for analysis. We found an ample seven-fold higher risk of severe cerebral injury in live-born children treated with amnioreduction compared to laser (OR 7.69, 95% CI 2.78-20.0, p = 0.00). In children surviving the neonatal period, the odds were three-times higher following amnioreduction (OR 3.23, 95% CI 1.45-7.14, p = 0.00). Although not significant, monochorionic twins treated with amnioreduction had higher odds of periventricular leukomalacia and intraventricular hemorrhage (OR 2.08, 95% CI 0.86-5.00, p = 0.10 and OR 3.56, 95% CI 0.82-14.29, p = 0.09). Unfortunately, there were insufficient long-term outcome data available to estimate the odds of neurodevelopmental impairment. CONCLUSION: Amnioreduction is associated with an increased risk of severe cerebral injury compared to laser surgery in twin-twin transfusion syndrome. Our study highlights a lack of studies focusing on long-term neurodevelopmental outcome. Follow-up into childhood is indispensable to determine outcome in terms of motor, cognitive and socioemotional development.
OBJECTIVE: To estimate the odds of severe cerebral injury and long-term neurodevelopmental impairment in monochorionic twins treated with amnioreduction versus laser surgery for twin-twin transfusion syndrome. METHODS: A systematic review and meta-analysis of studies on cerebral injury and long-term impairment after amnioreduction versus laser surgery were conducted. Odds ratios (OR) with their 95% confidence interval (CI) were computed. RESULTS: Electronic and manual search identified 63 references. Five studies were included for analysis. We found an ample seven-fold higher risk of severe cerebral injury in live-born children treated with amnioreduction compared to laser (OR 7.69, 95% CI 2.78-20.0, p = 0.00). In children surviving the neonatal period, the odds were three-times higher following amnioreduction (OR 3.23, 95% CI 1.45-7.14, p = 0.00). Although not significant, monochorionic twins treated with amnioreduction had higher odds of periventricular leukomalacia and intraventricular hemorrhage (OR 2.08, 95% CI 0.86-5.00, p = 0.10 and OR 3.56, 95% CI 0.82-14.29, p = 0.09). Unfortunately, there were insufficient long-term outcome data available to estimate the odds of neurodevelopmental impairment. CONCLUSION: Amnioreduction is associated with an increased risk of severe cerebral injury compared to laser surgery in twin-twin transfusion syndrome. Our study highlights a lack of studies focusing on long-term neurodevelopmental outcome. Follow-up into childhood is indispensable to determine outcome in terms of motor, cognitive and socioemotional development.
Authors: Tuangsit Wataganara; Arundhati Gosavi; Katika Nawapun; Pradip D Vijayakumar; Nisarat Phithakwatchara; Mahesh Choolani; Lin Lin Su; Arijit Biswas; Citra N Z Mattar Journal: J Vis Exp Date: 2018-03-21 Impact factor: 1.355
Authors: Asma Khalil; Helen Perry; James Duffy; Keith Reed; Ahmet Baschat; Jan Deprest; Kurt Hecher; Liesbeth Lewi; Enrico Lopriore; Dick Oepkes Journal: Trials Date: 2017-07-14 Impact factor: 2.279
Authors: Marjolijn S Spruijt; Ellen Tameeris; De-Peng Zhao; Johanna M Middeldorp; Monique C Haak; Dick Oepkes; Enrico Lopriore Journal: Fetal Diagn Ther Date: 2017-03-11 Impact factor: 2.587
Authors: Marjolijn S Spruijt; Enrico Lopriore; Ratna N G B Tan; Femke Slaghekke; Frans J C M Klumper; Johanna M Middeldorp; Monique C Haak; Dick Oepkes; Monique Rijken; Jeanine M M van Klink Journal: J Clin Med Date: 2019-08-15 Impact factor: 4.241