Clinical Department of Obstetrics and Gynecology, University Hospitals Leuven, Belgium, and Academic Department of Development and Regeneration, Cluster Woman and Child, Group Biomedical Sciences, KU Leuven, Leuven, Belgium.
Clinical Department of Obstetrics and Gynecology, University Hospitals Leuven, Belgium, and Academic Department of Development and Regeneration, Cluster Woman and Child, Group Biomedical Sciences, KU Leuven, Leuven, Belgium; Institute for Women's Health, University College London, London, United Kingdom.
Am J Obstet Gynecol. 2018 Apr;218(4):447.e1-447.e7. doi: 10.1016/j.ajog.2018.01.013. Epub 2018 Jan 12.
An improved survival and quality of life for neonatal survivors after fetoscopic laser therapy for twin-twin transfusion syndrome has been reported. However, little is known about the medium-term maternal effects after fetoscopic laser therapy with respect to reproductive and gynecologic outcomes.
The objective of this study was to document reproductive, obstetric, gynecological, and psychological outcomes in women who underwent fetoscopic laser therapy for twin-twin transfusion syndrome.
This was a monocentric controlled study on consecutive women who underwent fetoscopic laser therapy for twin-twin transfusion syndrome between 2007 and 2013 at the University Hospitals Leuven (cases; n = 198). Controls were women followed up during the same time period for an uncomplicated monochorionic diamniotic twin pregnancy and with an uneventful course (controls; n = 211). All patients received a questionnaire inquiring on their fertility, later pregnancies, and gynecological outcomes.
The response rate was 50.4% (cases: n = 95; controls: n = 109). Most baseline characteristics were similar across both groups. Women in the fetoscopic laser therapy group attempted a new pregnancy more frequently (34% [31 of 92] vs 21% [22 of 107] in controls; P < .05) and became pregnant more often (100% [31 of 31] vs 82% [18 of 22]; P < .05).We observed a shorter interpregnancy interval in cases than controls (median interval, 12 [interquartile range, 5-27] vs 24 [interquartile range, 15-30] months) (P < .05). This was also observed in cases who lost one or both fetuses or babies in the index pregnancy (median interval, 9 [interquartile range, 3.5-25.5] months; P < .05). The complication rate during subsequent pregnancies (26% [8 of 31] vs 11% [2 of 19]; P = .194) and at delivery (17% [5 of 30] vs 11% [2 of 19]; P = .554) were comparable. More women who underwent fetoscopic laser coagulation reported relevant psychological symptoms (44% [40 of 92] vs 21% [23 of 107]; P < .05). When only women in whom there was a double-surviving twin pair were considered, there were no differences in psychological symptoms compared with controls (16% [15 of 55] vs 21% [23 of 107]; P = .411). Gynecological problems were equally frequent in both groups (20% [18 of 92] vs 31% [33 of 107]; P = .069).
No adverse medium-term maternal effects with respect to fertility, obstetric, and gynecological outcomes were observed after fetoscopic laser therapy. However, these women reported more psychological or emotional problems than women with monochorionic diamniotic who did not have laser therapy, in particular when this was complicated by a fetal loss.
已经有报道称，接受胎儿镜激光治疗双胎输血综合征后，新生儿的存活率和生活质量得到了改善。然而，对于接受胎儿镜激光治疗的女性，关于生殖和妇科结局的中期母体影响，人们知之甚少。
本研究旨在记录因双胎输血综合征而接受胎儿镜激光治疗的女性的生殖、产科、妇科和心理结局。
这是一项单中心对照研究，纳入了 2007 年至 2013 年期间在鲁汶大学附属医院接受胎儿镜激光治疗的双胎输血综合征女性（病例组；n=198）。对照组为同期接受单纯绒毛膜性双羊膜囊双胎妊娠且无并发症的女性（n=211）。所有患者均收到一份调查问卷，询问其生育、后续妊娠和妇科结局。
应答率为 50.4%（病例组：n=95；对照组：n=109）。两组的大多数基线特征相似。胎儿镜激光治疗组的女性更频繁地尝试新的妊娠（34%[31/92] vs 21%[22/107]，对照组；P<0.05），并且更频繁地怀孕（100%[31/31] vs 82%[18/22]；P<0.05）。我们观察到病例组的妊娠间隔时间短于对照组（中位数间隔，12[四分位距，5-27] vs 24[四分位距，15-30]个月）（P<0.05）。在指数妊娠中失去一个或两个胎儿或婴儿的病例组中也观察到了这种情况（中位数间隔，9[四分位距，3.5-25.5]个月；P<0.05）。随后妊娠（26%[8/31] vs 11%[2/19]；P=0.194）和分娩时（17%[5/30] vs 11%[2/19]；P=0.554）的并发症发生率在两组之间无差异。更多接受胎儿镜激光凝固治疗的女性报告有相关的心理症状（44%[40/92] vs 21%[23/107]；P<0.05）。当仅考虑存在双存活胎儿的女性时，与对照组相比，心理症状无差异（16%[15/55] vs 21%[23/107]；P=0.411）。两组的妇科问题发生率相似（20%[18/92] vs 31%[33/107]；P=0.069）。
在接受胎儿镜激光治疗后，女性的中期生殖、产科和妇科结局未观察到不良影响。然而，与未接受激光治疗的单纯绒毛膜性双羊膜囊双胎妊娠女性相比，这些女性报告了更多的心理或情绪问题，尤其是在胎儿丢失的情况下。
