Perioperative risk factors of preterm delivery after fetoscopic laser photocoagulation for twin–twin transfusion syndrome. (7th February 2023)

• Record Type: Journal Article
• Authors: Yamamoto, Rumiko; Yamada, Takuma; Yamamoto, Ryo; Wagata, Maiko; Hayashi, Shusaku; Ishii, Keisuke
• Is Part Of: Prenatal diagnosis. Volume 43:Number 3(2023)
• Page Start: 393
• Page End: 399
• Publication Date: 2023-02-07
• Subjects: Prenatal diagnosis -- Periodicals; Fetus -- Diseases -- Diagnosis -- Periodicals; Electronic journals; 618.32075
• DOI: 10.1002/pd.6325
• Languages: English
• ISSNs: 0197-3851

Abstract

Abstract: Objective: To identify risk factors for preterm delivery (PTD) in patients who received fetoscopic laser photocoagulation (FLP) of placental anastomoses for twin–twin transfusion syndrome (TTTS). Methods: This retrospective cohort study prospectively analyzed and recorded perioperative data in a cohort of patients who had FLP for TTTS, identifying perioperative risk factors for PTD using a Cox proportional hazard regression model. Results: Of 304 patients included, 26 (8.6%) delivered within 4 weeks of FLP. Independent predictors of delivery within 4 weeks of FLP were a history of PTD (hazard ratio [HR]: 5.91, 95% confidence interval [CI]:1.21–28.82, p = 0.03), vaginal bleeding in the second trimester (HR: 6.62, 95% CI: 1.76–24.90, p < 0.01), and amnioreduction ≥1715 mL (HR: 3.16, 95% CI: 1.11–9.05, p < 0.03). Conclusion: Patients with a history of PTD, preoperative vaginal bleeding, and amnioreduction ≥1715 mL were more likely to deliver prematurely. Key points: What's already known about this topic? Fetoscopic laser photocoagulation (FLP) for twin–twin transfusion syndrome (TTTS) is associated with an increased incidence of preterm delivery (PTD). What does this study add? A history of PTD, preoperative vaginal bleeding, and a large amnioreduction volume are independent risk factors for spontaneous PTD after FLP. Shortened cervical length (CL), fetal fibronectin, and insulin‐like growth factor‐binding protein‐1 are factors not associated.