Snowise S, Mann L K, Moise K J, Johnson A, Bebbington M W, Papanna R
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology and Reproductive Sciences, UT Health-University of Texas Medical School at Houston and The Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA.
Ultrasound Obstet Gynecol. 2017 May;49(5):607-611. doi: 10.1002/uog.15958.
To assess the incidence, clinical course, risk factors and outcomes of preterm prelabor rupture of membranes (PPROM) after fetoscopic laser surgery (FLS) for twin-twin transfusion syndrome (TTTS).
This was a prospective observational cohort study of 154 consecutive cases of TTTS. PPROM was defined as rupture of membranes before 34 weeks' gestation. Procedure-to-PPROM and PPROM-to-delivery intervals were determined. Relevant preoperative and intraoperative variables were analyzed by univariate and multivariate logistic regression to determine their impact on PPROM after FLS.
The incidence of PPROM was 39% (n = 60), occurring at a mean gestational age of 27.2 ± 4.6 weeks. Median procedure-to-PPROM interval was 46 (range, 1-105; interquartile range (IQR), 13-66) days and median PPROM-to-delivery interval was 1 (range, 0-93; IQR, 0-13) day. Mean gestational age at delivery in cases with PPROM was 29.0 ± 4.5 weeks compared with 32.6 ± 3.9 weeks in cases without PPROM (P < 0.0001). Insertion of a collagen plug was the only significant factor found on both univariate and multivariate analysis to be associated with an increased rate of PPROM (odds ratio, 3.1 (95% CI, 1.2-8.0); P = 0.006). There was no statistically significant difference in fetal (P = 0.07) or neonatal (P = 0.08) survival between those with and those without PPROM.
PPROM after FLS increases prematurity by 3.6 weeks. The latency period after PPROM was 2 weeks; 50% of patients delivered within 24 h. No variable thought to be associated with PPROM after FLS was found to be significantly associated with this complication. Other etiologies and mechanisms for PPROM after FLS should be explored. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
评估胎儿镜激光手术（FLS）治疗双胎输血综合征（TTTS）后胎膜早破（PPROM）的发生率、临床病程、危险因素及结局。
这是一项对154例连续的TTTS病例进行的前瞻性观察队列研究。PPROM定义为妊娠34周前胎膜破裂。确定手术至PPROM以及PPROM至分娩的间隔时间。通过单因素和多因素逻辑回归分析相关术前和术中变量，以确定它们对FLS后PPROM的影响。
PPROM的发生率为39%（n = 60），发生时的平均孕周为27.2±4.6周。手术至PPROM的间隔时间中位数为46（范围1 - 105；四分位间距（IQR），13 - 66）天，PPROM至分娩的间隔时间中位数为1（范围0 - 93；IQR，0 - 13）天。发生PPROM的病例分娩时的平均孕周为29.0±4.5周，未发生PPROM的病例为32.6±3.9周（P < 0.0001）。单因素和多因素分析均发现，插入胶原塞是唯一与PPROM发生率增加相关的显著因素（比值比，3.1（95%CI，1.2 - 8.0）；P = 0.006）。发生PPROM和未发生PPROM的患者在胎儿（P = 0.07）或新生儿（P = 0.08）存活率方面无统计学显著差异。
FLS后PPROM使早产提前3.6周。PPROM后的潜伏期为2周；50%的患者在24小时内分娩。未发现任何被认为与FLS后PPROM相关的变量与该并发症有显著关联。应探索FLS后PPROM的其他病因和机制。版权所有©2016国际妇产科超声学会。由约翰·威利父子有限公司出版。
