Perinatal outcome after fetoscopic laser surgery for twin-to-twin transfusion syndrome in triplet pregnancies.

Abstract

OBJECTIVES:

The introduction of fetoscopic laser surgery of placental anastomoses has led to a significant improvement of perinatal outcome of twin pregnancies affected by twin-to-twin-transfusion syndrome (TTTS). To quantify the perinatal outcome and neurological morbidity in triplet pregnancies complicated by TTTS, which were treated with fetoscopic laser surgery.

SEARCH STRATEGY:

Medline, Embase, Cinahl and Cochrane were searched.

SELECTION CRITERIA:

The outcomes observed were: fetal and perinatal survival, preterm birth and abnormal neurological outcome.

DATA COLLECTION AND ANALYSIS:

Two authors reviewed all abstracts independently. Meta-analyses of proportions were used to combine data.

MAIN RESULTS:

Eight studies (126 triplet pregnancies, 104 dichorionic-triamniotic [DCTA] and 22 monochorionic-triamniotic [MCTA]) treated with fetoscopic laser surgery were included in this review. In DCTA and MCTA pregnancies, fetal losses were 18.9% and 28.9%, respectively; perinatal losses were 23.6% and 75.0%; preterm births <28 weeks of gestation were 16.9% and 37.1%; preterm births <32 weeks of gestation were 50.0% and 69.5%; at least one fetus survived in 95.4% and 88.9% of the pregnancies; at least two fetuses survived in 81.8% and 68.3% of the pregnancies; and in 55.9% and 48.4% pregnancies all triplets survived. Finally, the incidence of abnormal neurological outcomes ranged from 0 to 37% in DCTA and from 0 to 50% in MCTA triplets.

CONCLUSIONS:

Both DTCA and MCTA triplet pregnancies affected by TTTS are at high risk of adverse perinatal outcome.

TWEETABLE ABSTRACT:

Both DTCA and MCTA triplet pregnancies affected by TTTS are at high risk of adverse perinatal outcome.

• Authors: F D'Antonio, B Thilaganathan, J Toms, L Manzoli, A Bhide, A Papageorghiou, A Khalil
• Journal: BJOG : an international journal of obstetrics and gynaecology (BJOG) Vol. 123 Issue 3 Pg. 328-36 (Feb 2016) ISSN: 1471-0528 [Electronic] England
• PMID: 26265264 (Publication Type: Journal Article, Review)
• Copyright: © 2015 Royal College of Obstetricians and Gynaecologists.

Topics

• Female
• Fetofetal Transfusion (surgery)
• Fetoscopy (methods)
• Humans
• Infant, Newborn
• Laser Therapy
• Pregnancy
• Pregnancy Outcome
• Pregnancy, Triplet