Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Fetal Diagn Ther. 2020;47(6):464-470. doi: 10.1159/000503993. Epub 2019 Nov 13.
There are limited studies describing future reproductive outcomes in women who have had selective fetoscopic laser photocoagulation (SFLP) for twin-twin transfusion syndrome (TTTS).
Our study aims to compare reproductive outcomes following monochorionic multiple gestational pregnancies complicated by TTTS requiring SFLP to those not requiring SFLP.
This is a retrospective cohort study that analyzed records of patients who were evaluated at the Cincinnati Fetal Center (2007-2014) for monochorionic multiple gestations. A questionnaire regarding reproductive, obstetric, gynecologic, and psychological outcomes following the index pregnancy was administered to consented participants by electronic distribution. The data was compared between pregnancies with prior SFLP versus no prior SFLP.
There was a higher response rate in the SFLP group (219/474, 46.2%) versus the referent group (62/187, 33.2%). The median interval between the index pregnancy and survey completion was 74 months and 46 months in the SFLP and referent groups, respectively. Approximately 38 and 37% of the women in the SFLP and referent groups attempted conception after the index pregnancy with a >90% pregnancy success rate in both groups. Use of assisted reproductive technology was highly prevalent in both the index and subsequent pregnancies, with no significant difference between the groups. Over 60% of the women in each group did not attempt future pregnancy. Of those, approximately 1 in 3 cited the outcome of the index pregnancy as the primary reason for not pursuing future conception. There were no significant differences in selected maternal-fetal complications and new-onset gynecologic problems. More than 1 in 4 women in both groups were diagnosed with a mental health disorder following the index pregnancy.
SFLP does not appear to be associated with adverse reproductive, obstetric, or gynecologic outcomes. The data may help facilitate evidence-based counseling for this patient population.
目前仅有少数研究描述了接受选择性胎儿镜激光凝固术（SFLP）治疗双胎输血综合征（TTTS）的女性未来的生殖结局。
本研究旨在比较需要 SFLP 治疗和不需要 SFLP 治疗的 TTTS 合并单绒毛膜多胎妊娠的生殖结局。
这是一项回顾性队列研究，分析了 2007 年至 2014 年在辛辛那提胎儿中心接受单绒毛膜多胎妊娠评估的患者记录。通过电子方式向同意参与的患者分发了一份关于妊娠后生殖、产科、妇科和心理结局的调查问卷。比较了有既往 SFLP 治疗史的妊娠与无既往 SFLP 治疗史的妊娠。
SFLP 组（474 例中的 219 例，46.2%）的应答率高于对照组（187 例中的 62 例，33.2%）。SFLP 组和对照组的中位随访时间分别为 74 个月和 46 个月。在 SFLP 组和对照组中，约 38%和 37%的女性在指数妊娠后尝试妊娠，两组的妊娠成功率均>90%。两组中均广泛应用辅助生殖技术，两组间无显著差异。两组中超过 60%的女性未尝试再次妊娠。其中约 1/3 的人表示指数妊娠的结果是不考虑再次妊娠的主要原因。两组中均有近 1/4 的女性在指数妊娠后被诊断为精神健康障碍。
SFLP 似乎不会导致不良的生殖、产科或妇科结局。该数据可能有助于为该患者群体提供循证咨询。
