The Impact of Entry Technique and Access Diameter on Prelabour Rupture of Membranes Following Primary Fetoscopic Laser Treatment for Twin-Twin Transfusion Syndrome

Objective: To evaluate the impact of entry method and access diameter at fetoscopic surgery for twin-twin transfusion syndrome in twin pregnancies with at least one survivor. The outcomes evaluated were prelabour rupture of membranes (PROM) and birth <4 weeks, preterm birth (PTB) <28 weeks, and latency to birth. Methods: A retrospective analysis of prospectively collected data of consecutive laser procedures from 6 centers was performed. Three entry methods (sheath + trocar; cannula + trocar; cannula + Seldinger) and 6 access diameters (2.3, 3.0, 3.3, 3.5, 3.8, 4.0 mm) were used. Exclusion criteria were subsequent invasive interventions, termination of pregnancy or double fetal death after laser. Multivariate analysis was performed to determine risk factors for the study outcomes. Results: Six hundred seventy three fetoscopic laser cases were analyzed. The use of different entry methods and access diameters did not affect PROM or birth <4 weeks, or latency from laser to birth. Access diameter was associated with PTB <28 weeks. Cervical length was associated with PROM and birth <4 weeks, and latency from laser to birth. Conclusion: Instrument choice at fetoscopic laser procedures did not affect outcomes <4 weeks. Access diameter may affect the likelihood for PTB <28 weeks. Cervical length is critically associated with obstetrical outcomes following laser surgery.

[1]  Christopher S. Muratore,et al.  Iatrogenic Preterm Premature Rupture of Membranes after Fetoscopic Laser Ablative Surgery , 2014, Fetal Diagnosis and Therapy.

[2]  S. le Cessie,et al.  Risk Factors for Neurodevelopment Impairment in Twin–Twin Transfusion Syndrome Treated With Fetoscopic Laser Surgery , 2009, Obstetrics and gynecology.

[3]  Yuichiro Takahashi,et al.  Incidence and impact of perioperative complications in 175 fetoscopy-guided laser coagulations of chorionic plate anastomoses in fetofetal transfusion syndrome before 26 weeks of gestation. , 2005, American journal of obstetrics and gynecology.

[4]  F. Chan,et al.  Selective fetoscopic laser ablation in 100 consecutive pregnancies with severe twin–twin transfusion syndrome , 2009, The Australian & New Zealand journal of obstetrics & gynaecology.

[5]  K. Hecher,et al.  Neurodevelopmental outcome at 6 years of age after intrauterine laser therapy for twin‐twin transfusion syndrome , 2012, Acta paediatrica.

[6]  Roland Devlieger,et al.  Preterm Prelabor Rupture of Membranes and Fetal Survival after Minimally Invasive Fetal Surgery: A Systematic Review of the Literature , 2011, Fetal Diagnosis and Therapy.

[7]  T. Crombleholme,et al.  Incidence of complications in twin-twin transfusion syndrome after selective fetoscopic laser photocoagulation: a single-center experience. , 2009, American journal of obstetrics and gynecology.

[8]  J E De Lia,et al.  Fetoscopic neodymium: Yag laser occlusion of placental vessels in severe twin‐twin transfusion syndrome , 1990, Obstetrics and gynecology.

[9]  G. Acácio,et al.  Laser for the treatment of twin to twin transfusion syndrome. , 2005, Acta cirurgica brasileira.

[10]  K. Nicolaides,et al.  Cervical Length at 23 Weeks in Twins in Predicting Spontaneous Preterm Delivery , 1999, Obstetrics and gynecology.

[11]  J. Deprest,et al.  Instrumental requirements for minimal invasive fetal surgery , 2009, BJOG : an international journal of obstetrics and gynaecology.

[12]  R. Papanna,et al.  Absorbable gelatin plug does not prevent iatrogenic preterm premature rupture of membranes after fetoscopic laser surgery for twin–twin transfusion syndrome , 2013, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[13]  Vincenzo D'Addario,et al.  Laser therapy and serial amnioreduction as treatment for twin-twin transfusion syndrome: a metaanalysis and review of literature. , 2008, American journal of obstetrics and gynecology.

[14]  R. Favre,et al.  Cervical length and funneling at 22 and 27 weeks to predict spontaneous birth before 32 weeks in twin pregnancies: a French prospective multicenter study. , 2002, American journal of obstetrics and gynecology.

[15]  K. Hecher,et al.  Endoscopic laser coagulation of placental anastomoses in 200 pregnancies with severe mid-trimester twin-to-twin transfusion syndrome. , 2000, European journal of obstetrics, gynecology, and reproductive biology.

[16]  K. Hecher,et al.  Laser coagulation of placental anastomoses with a 30° fetoscope in severe mid‐trimester twin–twin transfusion syndrome with anterior placenta , 2008, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[17]  R. Joy,et al.  The association between early membrane rupture, latency, clinical chorioamnionitis, neonatal infection, and adverse perinatal outcomes in twin pregnancies complicated by preterm prelabour rupture of membranes. , 2003, Twin research : the official journal of the International Society for Twin Studies.

[18]  S. Trentacoste,et al.  Outcomes of preterm premature rupture of membranes in twin pregnancies , 2008, The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.

[19]  A. Baschat,et al.  Outcome after fetoscopic selective laser ablation of placental anastomoses vs equatorial laser dichorionization for the treatment of twin-to-twin transfusion syndrome. , 2013, American journal of obstetrics and gynecology.

[20]  N. Fisk,et al.  The basic and clinical science of twin-twin transfusion syndrome. , 2009, Placenta.

[21]  A. Welsh,et al.  Immediate outcome of twin–twin transfusion syndrome following selective laser photocoagulation of communicating vessels at the NSW Fetal Therapy Centre , 2010, The Australian & New Zealand journal of obstetrics & gynaecology.

[22]  R. Papanna,et al.  Chorioamnion Separation as a Risk for Preterm Premature Rupture of Membranes After Laser Therapy for Twin–Twin Transfusion Syndrome , 2010, Obstetrics and gynecology.

[23]  Y. Ville,et al.  Cervical length as a prognostic factor for preterm delivery in twin‐to‐twin transfusion syndrome treated by fetoscopic laser coagulation of chorionic plate anastomoses , 2005, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[24]  Y. Ville,et al.  Neonatal outcome in preterm monochorionic twins with twin-to-twin transfusion syndrome after intrauterine treatment with amnioreduction or fetoscopic laser surgery: comparison with dichorionic twins. , 2007, American journal of obstetrics and gynecology.

[25]  S. Carr,et al.  The Pediatric Surgeons’ Contribution to In Utero Treatment of Twin-to-Twin Transfusion Syndrome , 2009, Annals of surgery.

[26]  David W. Hosmer,et al.  Applied Logistic Regression , 1991 .

[27]  V. Berghella,et al.  Prediction of preterm premature rupture of membranes by transvaginal ultrasound features and risk factors in a high‐risk population , 2002, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[28]  B. Sibai,et al.  Clinical characteristics and outcome of twin gestation complicated by preterm premature rupture of the membranes. , 1993, American journal of obstetrics and gynecology.

[29]  J. Stockman,et al.  Endoscopic Laser Surgery Versus Serial Amnioreduction for Severe Twin-to-Twin Transfusion Syndrome , 2006 .