Bergh Eric P, Moise Kenneth J, Johnson Anthony, Papanna Ramesha
Department of Obstetrics, Gynecology and Reproductive Sciences, The Fetal Center, Children's Memorial Hermann Hospital, UTHealth, McGovern School of Medicine, University of Texas, Houston, Texas, USA.
Prenat Diagn. 2020 Jul;40(8):1020-1027. doi: 10.1002/pd.5725. Epub 2020 May 19.
We tested the hypothesis that increasing severity of chorioamnion membrane separation (CAS) after fetoscopic laser surgery (FLS) for twin-twin transfusion syndrome (TTTS) is associated with worse pregnancy outcomes.
Prospective cohort of patients undergoing FLS for TTTS between 2011 and 2018. CAS was defined as separation of fetal membranes from the uterine wall on post-operative ultrasound. Patient groups were defined: Group 1: No CAS; Group 2: CAS lower than 50th centile; Group 3: CAS upper than 50th centile or complete CAS. Comparative analysis was performed.
Of 387 patients meeting inclusion criteria, 29 (7.5%) had CAS (median 9.8 mm [4.9-30.8 mm]). Group 1 patients were more likely to undergo FLS at later gestational age, had increased recipient maximum vertical pocket, and higher amnioreduction volume than Group 3. Group 3 had higher rates of preterm premature rupture of membrane, delivered earlier and were more likely to terminate than Group 1. Group 2 had fewer neonatal survivors than Group 1. Survival analysis for gestational age at delivery and Cox proportional hazards model indicated increased risk for early delivery in Groups 2 and 3 compared with Group 1.
Patients with CAS ≥9.8 mm or complete CAS after FLS for TTTS had worse obstetric and neonatal outcomes.
我们检验了这样一个假设，即对于双胎输血综合征（TTTS）行胎儿镜激光手术（FLS）后绒毛膜羊膜分离（CAS）严重程度增加与更差的妊娠结局相关。
对2011年至2018年间因TTTS接受FLS的患者进行前瞻性队列研究。CAS定义为术后超声检查时胎膜与子宫壁分离。将患者分为三组：第1组：无CAS；第2组：CAS低于第50百分位数；第3组：CAS高于第50百分位数或完全性CAS。进行比较分析。
在387例符合纳入标准的患者中，29例（7.5%）发生CAS（中位数9.8毫米[4.9 - 30.8毫米]）。与第3组相比，第1组患者更可能在孕晚期接受FLS，受血儿最大垂直羊水池更大，羊水减量体积更多。与第1组相比，第3组胎膜早破发生率更高，分娩更早，终止妊娠的可能性更大。第2组新生儿存活者少于第1组。对分娩孕周的生存分析和Cox比例风险模型表明，与第1组相比，第2组和第3组早产风险增加。
TTTS行FLS后CAS≥9.8毫米或完全性CAS的患者产科和新生儿结局更差。
