Michael V Zaretsky1,2, Suhong Tong1, Megan Lagueux1,2, Foong-Yen Lim3, Nahla Khalek4, Stephen P Emery5, Sarah Davis6, Anita J Moon-Grady7, Kathryn Drennan8, Marjorie C Treadwell9, Erika Petersen10, Patricia Santiago-Munoz11, Richard Brown12. 1. University of Colorado School of Medicine, Aurora, CO. 2. Colorado Fetal Care Center, Aurora, CO. 3. Fetal Care Center of Cincinnati, Cincinnati, OH. 4. Children's Hospital of Philadelphia, Philadelphia, PA. 5. Magee-Womens Hospital, Pittsburgh, PA. 6. Providence -Brown Fetal Medicine Program, Providence, RI. 7. University of California San Francisco, San Francisco, CA. 8. University of Rochester Medical Center, Rochester, NY. 9. University of Michigan, Ann Arbor, MI. 10. Medical College of Wisconsin, Milwaukee, WI. 11. University of Texas Southwestern Medical Center, Dallas, TX. 12. McGill University Health Centre, Montreal, QC, Canada.
Abstract
Background: Despite improvements in fetal survival for pregnancies affected by twin-twin transfusion syndrome since the introduction of laser photocoagulation, prematurity remains a major source of neonatal morbidity and mortality. Objective: To investigate the indications and factors influencing the timing of delivery following laser treatment, we collected delivery information regarding twin-twin transfusion syndrome cases in a large multicenter cohort. Study Design: Eleven North American Fetal Therapy Network (NAFTNet) centers conducted a retrospective review of twin-twin transfusion syndrome patients who underwent laser photocoagulation. Clinical, demographic and ultrasound variables including twin-twin transfusion syndrome stage, and gestational age at treatment and delivery were recorded. Primary and secondary maternal and fetal indications for delivery were identified. Univariate analysis was used to select candidate variables with significant correlation with latency and GA at delivery. Multivariable Cox regression with competing risk analysis was utilized to determine the independent associations. Results: A total of 847 pregnancies were analyzed. After laser, the average latency to delivery was 10.11 ± 4.8 weeks and the mean gestational age at delivery was 30.7 ± 4.5 weeks. Primary maternal indications for delivery comprised 79% of cases. The leading indications included spontaneous labor (46.8%), premature rupture of membranes (17.1%), and placental abruption (8.4%). Primary fetal indications accounted for 21% of cases and the most frequent indications included donor non-reassuring status (20.5%), abnormal donor Dopplers (15.1%), and donor growth restriction (14.5%). The most common secondary indications for delivery were premature rupture of membranes, spontaneous labor and donor growth restriction. Multivariate modeling found gestational age at diagnosis, stage, history of prior amnioreduction, cerclage, interwin membrane disruption, procedure complications and chorioamniotic membrane separation as predictors for both gestational age at delivery and latency. Conclusion: Premature delivery after laser therapy for twin-twin transfusion syndrome is primarily due to spontaneous labor, preterm premature rupture of membranes and non-reassuring status of the donor fetus. Placental abruption was found to be a frequent complication resulting in early delivery. Future research should be directed toward the goal of prolonging gestation after laser photocoagulation to further reduce morbidity and mortality associated with twin-twin transfusion syndrome.
Background: Despite improvements in fetal survival for pregnancies affected by twin-twin transfusion syndrome since the introduction of laser photocoagulation, prematurity remains a major source of neonatal morbidity and mortality. Objective: To investigate the indications and factors influencing the timing of delivery following laser treatment, we collected delivery information regarding twin-twin transfusion syndrome cases in a large multicenter cohort. Study Design: Eleven North American Fetal Therapy Network (NAFTNet) centers conducted a retrospective review of twin-twin transfusion syndrome patients who underwent laser photocoagulation. Clinical, demographic and ultrasound variables including twin-twin transfusion syndrome stage, and gestational age at treatment and delivery were recorded. Primary and secondary maternal and fetal indications for delivery were identified. Univariate analysis was used to select candidate variables with significant correlation with latency and GA at delivery. Multivariable Cox regression with competing risk analysis was utilized to determine the independent associations. Results: A total of 847 pregnancies were analyzed. After laser, the average latency to delivery was 10.11 ± 4.8 weeks and the mean gestational age at delivery was 30.7 ± 4.5 weeks. Primary maternal indications for delivery comprised 79% of cases. The leading indications included spontaneous labor (46.8%), premature rupture of membranes (17.1%), and placental abruption (8.4%). Primary fetal indications accounted for 21% of cases and the most frequent indications included donor non-reassuring status (20.5%), abnormal donor Dopplers (15.1%), and donor growth restriction (14.5%). The most common secondary indications for delivery were premature rupture of membranes, spontaneous labor and donor growth restriction. Multivariate modeling found gestational age at diagnosis, stage, history of prior amnioreduction, cerclage, interwin membrane disruption, procedure complications and chorioamniotic membrane separation as predictors for both gestational age at delivery and latency. Conclusion: Premature delivery after laser therapy for twin-twin transfusion syndrome is primarily due to spontaneous labor, preterm premature rupture of membranes and non-reassuring status of the donor fetus. Placental abruption was found to be a frequent complication resulting in early delivery. Future research should be directed toward the goal of prolonging gestation after laser photocoagulation to further reduce morbidity and mortality associated with twin-twin transfusion syndrome.
Authors: Ramesha Papanna; Mounira Habli; Ahmet A Baschat; Michael Bebbington; Lovepreet K Mann; Anthony Johnson; Greg Ryan; Martin Walker; David Lewis; Christopher Harman; Timothy Crombleholme; Kenneth J Moise Journal: Am J Obstet Gynecol Date: 2012-02-28 Impact factor: 8.661
Authors: Paul A Harris; Robert Taylor; Robert Thielke; Jonathon Payne; Nathaniel Gonzalez; Jose G Conde Journal: J Biomed Inform Date: 2008-09-30 Impact factor: 6.317
Authors: Ramen H Chmait; Lisa M Korst; Arlyn Llanes; Patrick Mullin; Richard H Lee; Joseph G Ouzounian Journal: Am J Obstet Gynecol Date: 2013-06-07 Impact factor: 8.661
Authors: J U Ortiz; E Eixarch; A Peguero; S M Lobmaier; M Bennasar; J M Martinez; E Gratacós Journal: Ultrasound Obstet Gynecol Date: 2016-02-04 Impact factor: 7.299
Authors: S H P Peeters; T T Stolk; F Slaghekke; J M Middeldorp; F J Klumper; E Lopriore; D Oepkes Journal: Ultrasound Obstet Gynecol Date: 2014-09-22 Impact factor: 7.299
Authors: Marie-Victoire Senat; Jan Deprest; Michel Boulvain; Alain Paupe; Norbert Winer; Yves Ville Journal: N Engl J Med Date: 2004-07-06 Impact factor: 91.245