Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.
Department of Fetal Medicine & Prenatal Diagnosis Center, Shanghai 1st Maternity and Infant Hospital of Tongji University, Shanghai, China.
Fetal Diagn Ther. 2021;48(9):660-666. doi: 10.1159/000517800. Epub 2021 Sep 23.
Twin-twin transfusion syndrome (TTTS) is a complication in monochorionic twin pregnancies which is preferably treated with fetoscopic laser surgery. A few small studies suggested a possible association between the Solomon laser technique and placental abruption.
The objective of this study is to compare the rate of and to explore potential risk factors for placental abruption in TTTS treated with fetoscopic laser surgery according to the Selective and Solomon laser technique. We conducted a large retrospective cohort study of consecutive TTTS-cases treated with fetoscopic laser surgery in Shanghai, China, and Leiden, The Netherlands treated with either the Selective laser technique (Selective group) or Solomon laser technique (Solomon group).
The rate of placental abruption in the Selective group versus the Solomon group was 1.7% (5/289) and 3.4% (15/441), respectively (p = 0.184). No risk factors for placental abruption were identified. Placental abruption was associated with lower gestational age at birth (p = 0.003) and severe cerebral injury (p = 0.003).
The prevalence of placental abruption in TTTS after fetoscopic laser surgery is low, although it appears higher than in the overall population. Placental abruption is associated with a lower gestational age at birth, which is associated with severe cerebral injury. The rate of placental abruption was not significantly increased with the use of the Solomon technique. Continued research of placental abruption in TTTS is necessary to determine why the rate is higher than in the overall population.
双胎输血综合征（TTTS）是一种绒毛膜性单卵双胎妊娠的并发症，最好采用腔内激光手术治疗。少数小型研究表明，腔内激光手术的 Solomon 技术与胎盘早剥之间可能存在关联。
本研究旨在比较根据选择性激光技术和 Solomon 激光技术治疗 TTTS 后胎盘早剥的发生率，并探讨其潜在的危险因素。我们对在中国上海和荷兰莱顿接受腔内激光手术治疗的连续 TTTS 病例进行了一项大型回顾性队列研究，这些病例分别采用选择性激光技术（选择性组）或 Solomon 激光技术（Solomon 组）治疗。
选择性组和 Solomon 组的胎盘早剥发生率分别为 1.7%（5/289）和 3.4%（15/441）（p = 0.184）。未发现胎盘早剥的危险因素。胎盘早剥与出生时的胎龄较低（p = 0.003）和严重的脑损伤（p = 0.003）相关。
虽然 TTTS 经腔内激光手术后胎盘早剥的发生率似乎高于一般人群，但仍较低。胎盘早剥与胎龄较低相关，而胎龄较低与严重的脑损伤相关。使用 Solomon 技术并未显著增加胎盘早剥的发生率。需要进一步研究 TTTS 中的胎盘早剥，以确定为何其发生率高于一般人群。
