Division of Neonatology, Department of Pediatrics, the Department of Pathology, the Division of Fetal Medicine, Department of Obstetrics, and the Department of Medical Statistics, Leiden University Medical Center, Leiden, the Netherlands; and the Department of Pathology, Women and Infants Hospital, Providence, Rhode Island.
Obstet Gynecol. 2016 Aug;128(2):304-312. doi: 10.1097/AOG.0000000000001469.
To estimate the incidence of histologic chorioamnionitis and funisitis after fetoscopic laser surgery for the management of twin-twin transfusion syndrome.
A case-control study was performed at the Leiden University Medical Center from 2013 to 2014. All patients with twin-twin transfusion syndrome managed with laser surgery during the study period were included and compared with a control group of all monochorionic twins not treated with laser surgery. We excluded patients with fetal demise or higher order pregnancies. Placentas were reviewed for the presence and degree of chorioamnionitis and presence or absence of fetal inflammatory response. The primary outcome was the incidence of histologic chorioamnionitis and funisitis after laser surgery. Odds ratios (ORs) and 95% confidence intervals (CIs) for primary outcomes were calculated. A P value of <.05 was considered as statistical significance.
Sixty-two patients treated with laser surgery were included in the study group and compared with 64 patients in the control group. The incidence of histologic chorioamnionitis was 13% (8/62) in the laser group compared with 5% (3/64) in the control group (OR 3.0, 95% CI 0.8-11.9, P=.12). Funisitis occurred in 8% (10/124) in the laser group compared with 0% in the control group (OR 11.1, 95% CI 1.3-96.9, P=.03). Histologic chorioamnionitis with or without funisitis after laser surgery was associated with a shorter laser-to-delivery interval (median 6.6 [range 3.4-14.1] compared with 13.6 [4.4-20.1] weeks, P<.01) and lower gestational age at birth (median 28.1 [range 23.1-32.6] compared with 32.7 [24.4-37.0] weeks, P<.01).
These findings suggest that laser surgery for twin-twin transfusion syndrome is associated with an increased risk of funisitis.
评估胎儿镜激光手术治疗双胎输血综合征后发生组织学绒毛膜羊膜炎和脐带炎的发生率。
这是一项 2013 年至 2014 年在莱顿大学医学中心进行的病例对照研究。所有在研究期间接受激光手术治疗的双胎输血综合征患者均被纳入研究，并与未接受激光手术治疗的所有单绒毛膜双胞胎对照组进行比较。我们排除了胎儿死亡或多胎妊娠的患者。检查胎盘是否存在和程度的绒毛膜羊膜炎和是否存在胎儿炎症反应。主要结局是激光手术后组织学绒毛膜羊膜炎和脐带炎的发生率。计算主要结局的比值比（ORs）和 95%置信区间（CIs）。P 值<.05 被认为具有统计学意义。
本研究纳入了 62 例接受激光手术治疗的患者作为研究组，并与对照组的 64 例患者进行了比较。激光组组织学绒毛膜羊膜炎的发生率为 13%（8/62），对照组为 5%（3/64）（OR 3.0，95%CI 0.8-11.9，P=.12）。激光组 124 例中有 8%（10/124）发生脐带炎，对照组为 0%（OR 11.1，95%CI 1.3-96.9，P=.03）。激光手术后出现组织学绒毛膜羊膜炎伴或不伴脐带炎与激光至分娩的时间间隔较短（中位数 6.6 [范围 3.4-14.1] 与 13.6 [4.4-20.1] 周，P<.01）和出生时的胎龄较低（中位数 28.1 [范围 23.1-32.6] 与 32.7 [24.4-37.0] 周，P<.01）相关。
这些发现表明，胎儿镜激光手术治疗双胎输血综合征与脐带炎的风险增加相关。
