Perioperative characteristics associated with preterm birth in twin-twin transfusion syndrome treated by laser surgery.

Abstract

OBJECTIVE:

To identify perioperative risk factors for preterm delivery (PTD) in laser-treated patients with twin-twin transfusion syndrome (TTTS).

STUDY DESIGN:

Twin-twin transfusion syndrome patients who underwent laser surgery were followed prospectively. Univariate and multivariate analyses were performed to identify gestational and surgical characteristics associated with preterm delivery.

RESULTS:

Of 318 eligible patients, the mean (SD) gestational age of delivery was 32.8 (4.2) weeks. The number of days from laser surgery to delivery had a bimodal distribution; group I delivered within 21 days and group II delivered after 21 days of surgery. Eighteen patients (5.7%) were in group I and demonstrated the following risk factors for delivery within 21 days: incomplete laser surgery suspected (odds ratio [OR], 11.14; P = .0106), preoperative subchorionic hematoma (OR, 7.92, P = .0361), preoperative cervical length <2.0 cm (OR, 4.71; P = .0117), and recipient's maximum vertical pocket ≥14 cm (OR, 3.23; P = .0335). In group II, 92 of 300 patients (30.7%) delivered <32 weeks, and 25 (8.3%) delivered <28 weeks; multivariate logistic regression analyses identified 5 risk factors for delivery <32 weeks: incomplete laser surgery suspected (OR, 10.0; P = .0506); incidental septostomy (OR, 4.4; P = .0009); triplet gestation (OR, 2.6; P = .0689); postoperative membrane detachment (OR, 2.4; P = .0393); and nonposterior placental location (OR, 1.8; P = .0282).

CONCLUSION:

Timing of delivery after laser for twin-twin transfusion syndrome has a bimodal distribution with distinct gestational and surgical risk factors. This information may be useful in counseling patients and in directing future avenues of research.

• Authors: Ramen H Chmait, Lisa M Korst, Arlyn Llanes, Patrick Mullin, Richard H Lee, Joseph G Ouzounian
• Journal: American journal of obstetrics and gynecology (Am J Obstet Gynecol) Vol. 209 Issue 3 Pg. 264.e1-8 (Sep 2013) ISSN: 1097-6868 [Electronic] United States
• PMID: 23747839 (Publication Type: Journal Article, Twin Study)
• Copyright: Copyright © 2013 Mosby, Inc. All rights reserved.

Topics

• Adolescent
• Adult
• Counseling
• Female
• Fetofetal Transfusion (surgery)
• Humans
• Laser Therapy
• Logistic Models
• Middle Aged
• Pregnancy
• Premature Birth (etiology)
• Prospective Studies
• Risk Factors
• Time Factors