Richard D. Wood Jr Center for Fetal Diagnosis & Treatment, Department of General, Thoracic & Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Fetal Diagn Ther. 2022;49(7-8):340-346. doi: 10.1159/000526484. Epub 2022 Aug 16.
We sought to determine if maternal obesity, defined by body mass index (BMI) 30-34.9 or BMI ≥35, negatively impacts the technical aspects and pregnancy outcomes in women treated with selective laser photocoagulation of placental communicating vessels for twin-twin transfusion syndrome (TTTS).
Retrospective review of women undergoing laser for TTTS from January 2010 to December 2021. Outcomes were stratified based on maternal BMI <30, 30-34.9, and ≥35. Data obtained included maternal age, parity, ethnicity, gestational age at laser, placental location, Quintero stage, CHOP cardiovascular score, operative and anesthesia times, procedure-to-delivery interval, gestational age at delivery, survival to birth, survival to discharge, and the presence of residual anastomoses. Statistical analysis included the χ2 or Fisher's exact test for categorical variables and the Mann-Whitney U test for continuous variables with p < 0.05 being significant.
A total of 434 women underwent laser for TTTS during the study period. Of those, 274 (63%) had a BMI of <30, 92 (21.2%) had a BMI between 30 and 34.9, and 68 (15.7%) had a BMI ≥ 35. There were no differences in maternal age, parity or ethnicity, Quintero stage, CHOP cardiovascular score, placental location, operative time, laser-to-delivery interval, gestational age at delivery, survival outcomes, or the presence of residual anastomoses between the three groups. Patients with a BMI of 30-34.9 were operated on at a slightly later gestational age, and those with a BMI > 35 had longer operative and anesthesia times. There were no technical failures as a result of BMI ≥ 30 or 35.
Using appropriate technical adjustments, outcomes for obese women undergoing laser for TTTS are similar to nonobese women, although patients with BMI ≥35 have longer operative and anesthesia times.
我们旨在确定肥胖（BMI 为 30-34.9 或 BMI≥35）是否会对接受选择性激光胎盘吻合血管凝固术治疗双胎输血综合征（TTTS）的女性的技术方面和妊娠结局产生负面影响。
回顾性分析 2010 年 1 月至 2021 年 12 月接受激光治疗 TTTS 的女性。根据母亲 BMI<30、30-34.9 和≥35 进行分层。获得的数据包括母亲年龄、产次、种族、激光时的孕龄、胎盘位置、Quintero 分期、CHOP 心血管评分、手术和麻醉时间、手术至分娩间隔、分娩时的孕龄、存活至出生、存活至出院以及吻合口残留情况。统计学分析包括分类变量的卡方检验或 Fisher 确切检验和连续变量的 Mann-Whitney U 检验，p<0.05 为有统计学意义。
在研究期间，共有 434 名女性接受激光治疗 TTTS。其中，274 名（63%）BMI<30，92 名（21.2%）BMI 在 30-34.9 之间，68 名（15.7%）BMI≥35。三组间母亲年龄、产次或种族、Quintero 分期、CHOP 心血管评分、胎盘位置、手术时间、激光至分娩间隔、分娩时的孕龄、存活结局或吻合口残留情况无差异。BMI 在 30-34.9 之间的患者手术时间略晚，BMI>35 的患者手术和麻醉时间较长。BMI≥30 或 35 并没有导致技术失败。
对于接受激光治疗 TTTS 的肥胖女性，虽然 BMI≥35 的患者手术和麻醉时间较长，但通过适当的技术调整，其结局与非肥胖女性相似。
