Maggio Lindsay, Carr Stephen R, Watson-Smith Debra, O'Brien Barbara M, Lopes Vrishali, Muratore Christopher S, Luks Francois I
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Women and Infants Hospital, Providence, R.I., USA.
Fetal Diagn Ther. 2015;38(1):29-34. doi: 10.1159/000369250. Epub 2014 Nov 22.
To describe the incidence and risk factors for iatrogenic premature preterm rupture of membranes (iPPROM) after fetoscopic laser surgery for the twin-to-twin-transfusion syndrome.
This is a retrospective review of all patients who have undergone fetoscopic laser surgery at a single fetal treatment center since 2000. We defined iPPROM as spontaneous rupture of membranes before the onset of labor prior to 34 weeks of gestation. The iPPROM cohort was compared to the cohort without iPPROM for several preoperative, operative, and delivery characteristics.
Ninety-two consecutive patients were reviewed. The overall rate of iPPROM was 18.5% (n = 17). The rates of iPPROM within 1 and 4 weeks were 5.4 and 10.9%, respectively. The median interval from surgery to delivery was significantly shorter in the iPPROM group (21 vs. 62 days, p = 0.01). The mean gestational age at delivery (27.0 vs. 31.1 weeks, p = 0.02) was lower in the iPPROM group. No other characteristics studied differed significantly between the groups.
The incidence of iPPROM was substantially lower than in recent multicenter reports; however, no risk factors of iPPROM could be identified. Whether this is related to variations in surgical or anesthetic management will require further investigation.
描述双胎输血综合征胎儿镜激光手术后医源性早产胎膜早破（iPPROM）的发生率及危险因素。
这是一项对自2000年以来在单一胎儿治疗中心接受胎儿镜激光手术的所有患者的回顾性研究。我们将iPPROM定义为妊娠34周前分娩发动前胎膜自发破裂。将发生iPPROM的队列与未发生iPPROM的队列在术前、手术及分娩的若干特征方面进行比较。
对92例连续患者进行了回顾。iPPROM的总体发生率为18.5%（n = 17）。1周内及4周内iPPROM的发生率分别为5.4%和10.9%。iPPROM组从手术到分娩的中位间隔时间显著更短（21天对62天，p = 0.01）。iPPROM组的平均分娩孕周更低（27.0周对31.1周，p = 0.02）。两组间研究的其他特征无显著差异。
iPPROM的发生率显著低于近期多中心报告；然而，未能识别出iPPROM的危险因素。这是否与手术或麻醉管理的差异有关尚需进一步研究。
