The Fetal Center, Department of Obstetrics, Children's Memorial Hermann Hospital, Gynecology and Reproductive Sciences, UTHealth, McGovern Medical School, University of Texas, Houston, Texas, USA.
Texas Children's Fetal Center, Departments of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA.
Fetal Diagn Ther. 2020;47(6):451-456. doi: 10.1159/000501774. Epub 2019 Sep 5.
Fetoscopic laser photocoagulation (FLP) is the definitive treatment for twin-twin transfusion syndrome (TTTS). Due to variability in geographic proximity to high-volume fetal centers, many patients travel great distances to receive experienced care. We sought to determine whether distance traveled (DT) is associated with gestational age (GA) at delivery and neonatal survival.
A prospective cohort study of patients within the continental United States referred to our center between September 23, 2011 and July 25, 2018 undergoing planned FLP for TTTS (n = 393; GA 20.6 ± 2.5 weeks; stage I: n = 50; stage II: n = 118; stage III: n = 208; stage IV: n = 17) was performed. The great-circle distance to our center was calculated using patients' home zip codes. DT was stratified into groups containing equal patient numbers and pregnancy outcomes assessed.
A total of 393 patients met the inclusion criteria. The threshold distance from our center was <250 miles (n = 181), 250-499 miles (n= 119), and ≥500 miles (n = 93). There was no significant difference between any of the preoperative variables among the three groups, with the exception of race and rural status. Furthermore, there was no significant association between DT and GA at delivery (p = 0.34), time interval from procedure to delivery (p = 0.37), and the number of neonatal survivors (p= 0.21). Preterm premature rupture of membranes (PPROM) at <34 weeks was highest (47.9%, p = 0.04) in the group traveling 250-499 miles.
To our knowledge, this is the largest study to show that in TTTS, DT is not associated with GA at delivery, time interval from procedure to delivery, or neonatal survival. Although PPROM at <34 weeks was higher in the group traveling 250-499 miles, there was no significant difference in GA at delivery. While patients with advanced disease may choose to seek treatment based on proximity, traveling long distances does not adversely affect pregnancy outcomes.
羊膜镜激光光凝术（FLP）是治疗双胎输血综合征（TTTS）的确定性治疗方法。由于与大容量胎儿中心的地理位置不同，许多患者需要长途跋涉才能获得专业护理。我们试图确定旅行距离（DT）是否与分娩时的胎龄（GA）和新生儿存活率相关。
对 2011 年 9 月 23 日至 2018 年 7 月 25 日期间，因 TTTS 到我们中心接受计划中的 FLP 的美国大陆患者（GA 为 20.6 ± 2.5 周；I 期：n = 50；II 期：n = 118；III 期：n = 208；IV 期：n = 17）进行了前瞻性队列研究。使用患者的家庭邮政编码计算到我们中心的大圆距离。将 DT 分为包含相等患者数量的组，并评估妊娠结局。
共有 393 名患者符合纳入标准。以我们中心为起点，距离<250 英里（n = 181）、250-499 英里（n = 119）和≥500 英里（n = 93）的患者分别为三组。除种族和农村地位外，三组患者的术前变量之间没有显著差异。此外，DT 与分娩时 GA（p = 0.34）、从手术到分娩的时间间隔（p = 0.37）和新生儿存活数（p = 0.21）之间没有显著相关性。<34 周的早产胎膜早破（PPROM）在旅行 250-499 英里的组中最高（47.9%，p = 0.04）。
据我们所知，这是最大的一项研究，表明在 TTTS 中，DT 与分娩时 GA、从手术到分娩的时间间隔或新生儿存活率无关。尽管旅行 250-499 英里的组中<34 周的 PPROM 更高，但分娩时 GA 没有显著差异。虽然晚期疾病患者可能会根据距离选择治疗，但长途跋涉不会对妊娠结局产生不利影响。
