Abstract | Background: 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:
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Authors | Michael V Zaretsky, Suhong Tong, Megan Lagueux, Foong-Yen Lim, Nahla Khalek, Stephen P Emery, Sarah Davis, Anita J Moon-Grady, Kathryn Drennan, Marjorie C Treadwell, Erika Petersen, Patricia Santiago-Munoz, Richard Brown, North American Fetal Therapy Network |
Journal | American journal of obstetrics & gynecology MFM
(Am J Obstet Gynecol MFM)
Vol. 1
Issue 1
Pg. 74-81
(03 2019)
ISSN: 2589-9333 [Electronic] United States |
PMID | 32832884
(Publication Type: Journal Article, Multicenter Study, Research Support, N.I.H., Extramural)
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Topics |
- Female
- Fetal Therapies
- Fetofetal Transfusion
(surgery)
- Fetoscopy
- Humans
- Infant, Newborn
- Laser Therapy
(adverse effects)
- Placenta
- Pregnancy
- Retrospective Studies
- United States
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