Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, the Fetal Care Center and the Department of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Good Samaritan Hospital, Cincinnati, and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Riverside Methodist Hospital, Columbus, Ohio.
Obstet Gynecol. 2022 Dec 1;140(6):965-973. doi: 10.1097/AOG.0000000000004970. Epub 2022 Nov 2.
To describe the pregnancy outcomes of patients who experienced previable and periviable prelabor rupture of membranes (PROM) after the treatment of twin-twin transfusion syndrome.
We conducted a retrospective cohort study of patients whose pregnancies were complicated by twin-twin transfusion syndrome who were treated with fetoscopic laser photocoagulation at a single fetal center and subsequently experienced PROM from April 2010 to June 2019. Outcomes were infant survival and latency from PROM to delivery. Patients were grouped by gestational age at PROM (before 26 weeks of gestation and 26 weeks or later). The group with PROM before 26 weeks of gestation was stratified by gestational age at PROM for further description of outcomes.
Two-hundred fifty of 653 patients (38%) developed PROM, 81 before 26 weeks of gestation and 169 after 26 weeks of gestation. In the setting of PROM before 26 weeks of gestation, the rate of survival of both twins to neonatal intensive care unit (NICU) discharge was 46.3%, compared with 76.9% in the setting of PROM at 26 weeks of gestation or later ( P <.001); the survival rate of at least one twin was 61.2% and 98.5%, respectively ( P <.001). Fourteen, 22, and 45 patients experienced PROM at 16-19 6/7, 20-22 6/7, and 23-25 6/7 weeks of gestation, respectively. Survival of both twins and at least one twin to NICU discharge was 25.0%, 47.4%, 52.8% (for two) and 33.3%, 47.4%, and 77.8% (for at least one), respectively, among those groups. Fifty-seven of the 81 patients with PROM before 26 weeks of gestation experienced a latency longer than 48 hours. In the setting of PROM before 26 weeks of gestation, when latency lasted longer than 48 hours, overall survival was improved (69.6% vs 53.7%, respectively, P =.017). With latency longer than 48 hours and PROM at 16-19 6/7, 20-22 6/7, and 23-25 6/7 weeks of gestation, survival of both twins to NICU discharge was 60.0%, 61.5%, and 60.7%, respectively, and survival of at least one twin was 80.0%, 61.5%, and 85.7%, respectively.
Earlier gestational age at PROM after laser photocoagulation is associated with longer latency but lower rates of survival. When PROM occurs before 26 weeks of gestation and latency exceeds 48 hours, rates of neonatal survival are significantly improved.
描述接受激光凝固治疗后的双胎输血综合征患者发生早产胎膜早破（PPROM）的妊娠结局。
我们对在一家胎儿中心接受激光凝固治疗后发生早产胎膜早破的双胎输血综合征患者进行了回顾性队列研究，研究时间为 2010 年 4 月至 2019 年 6 月。研究结局为婴儿的存活率和从胎膜早破到分娩的潜伏期。根据胎膜早破时的孕周（<26 周和≥26 周）将患者分为两组。对于<26 周胎膜早破的患者，根据胎膜早破时的孕周进一步分层，以描述结局。
在 653 例患者中，有 250 例（38%）发生了胎膜早破，其中 81 例发生在<26 周，169 例发生在≥26 周。在<26 周胎膜早破的情况下，双胞胎均存活至新生儿重症监护病房（NICU）出院的比例为 46.3%，而在≥26 周胎膜早破的情况下为 76.9%（P<.001）；至少有一只存活的双胞胎的比例分别为 61.2%和 98.5%（P<.001）。14 例、22 例和 45 例患者分别在 16-19 6/7 周、20-22 6/7 周和 23-25 6/7 周发生胎膜早破。在这些组中，双胞胎均存活至 NICU 出院的比例分别为 25.0%、47.4%、52.8%（均存活）和 33.3%、47.4%和 77.8%（至少存活一只）；至少存活一只的比例分别为 25.0%、47.4%、52.8%（均存活）和 33.3%、47.4%和 77.8%（至少存活一只）。在<26 周胎膜早破的 81 例患者中，有 57 例的潜伏期超过 48 小时。在<26 周胎膜早破的情况下，当潜伏期超过 48 小时时，总体存活率提高（分别为 69.6%和 53.7%，P=.017）。当潜伏期超过 48 小时且胎膜早破发生在 16-19 6/7 周、20-22 6/7 周和 23-25 6/7 周时，双胞胎均存活至 NICU 出院的比例分别为 60.0%、61.5%和 60.7%，至少存活一只的比例分别为 80.0%、61.5%和 85.7%。
激光凝固治疗后胎膜早破的孕周越早，潜伏期越长，存活率越低。当胎膜早破发生在<26 周且潜伏期超过 48 小时时，新生儿存活率显著提高。
