Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Am J Obstet Gynecol. 2013 Sep;209(3):264.e1-8. doi: 10.1016/j.ajog.2013.05.025. Epub 2013 Jun 7.
To identify perioperative risk factors for preterm delivery (PTD) in laser-treated patients with twin-twin transfusion syndrome (TTTS).
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.
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).
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.
确定接受激光治疗的双胎输血综合征（TTTS）患者围手术期早产（PTD）的相关风险因素。
对接受激光手术的 TTTS 患者进行前瞻性随访。采用单因素和多因素分析确定与早产相关的妊娠和手术特征。
在 318 名符合条件的患者中，分娩时的平均（SD）孕周为 32.8（4.2）周。从激光手术到分娩的天数呈双峰分布；第 I 组在 21 天内分娩，第 II 组在手术后 21 天以上分娩。18 名（5.7%）患者在第 I 组，在 21 天内分娩的风险因素包括：疑似激光手术不完整（优势比 [OR]，11.14；P =.0106）、术前胎盘下血肿（OR，7.92，P =.0361）、术前宫颈长度<2.0cm（OR，4.71；P =.0117）和受者最大垂直囊腔≥14cm（OR，3.23；P =.0335）。在第 II 组中，300 名患者中有 92 名（30.7%）在<32 周分娩，25 名（8.3%）在<28 周分娩；多因素 logistic 回归分析确定了 5 个<32 周分娩的风险因素：疑似激光手术不完整（OR，10.0；P =.0506）、偶然隔切开术（OR，4.4；P =.0009）、三胎妊娠（OR，2.6；P =.0689）、术后膜分离（OR，2.4；P =.0393）和非后位胎盘位置（OR，1.8；P =.0282）。
激光治疗双胎输血综合征后的分娩时机呈双峰分布，具有明显的妊娠和手术风险因素。这些信息可能有助于对患者进行咨询，并为未来的研究方向提供指导。
