双胎输血综合征胎儿镜激光光凝术后早产的围手术期危险因素

Perioperative risk factors of preterm delivery after fetoscopic laser photocoagulation for twin-twin transfusion syndrome.

作者信息

Yamamoto Rumiko, Yamada Takuma, Yamamoto Ryo, Wagata Maiko, Hayashi Shusaku, Ishii Keisuke

机构信息

Department of Fetal Maternal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan.

出版信息

Prenat Diagn. 2023 Mar;43(3):393-399. doi: 10.1002/pd.6325. Epub 2023 Feb 7.

DOI:10.1002/pd.6325

PMID:36726286

Abstract

OBJECTIVE

To identify risk factors for preterm delivery (PTD) in patients who received fetoscopic laser photocoagulation (FLP) of placental anastomoses for twin-twin transfusion syndrome (TTTS).

METHODS

This retrospective cohort study prospectively analyzed and recorded perioperative data in a cohort of patients who had FLP for TTTS, identifying perioperative risk factors for PTD using a Cox proportional hazard regression model.

RESULTS

Of 304 patients included, 26 (8.6%) delivered within 4 weeks of FLP. Independent predictors of delivery within 4 weeks of FLP were a history of PTD (hazard ratio [HR]: 5.91, 95% confidence interval [CI]:1.21-28.82, p = 0.03), vaginal bleeding in the second trimester (HR: 6.62, 95% CI: 1.76-24.90, p < 0.01), and amnioreduction ≥1715 mL (HR: 3.16, 95% CI: 1.11-9.05, p < 0.03).

CONCLUSION

Patients with a history of PTD, preoperative vaginal bleeding, and amnioreduction ≥1715 mL were more likely to deliver prematurely.

摘要

目的

确定接受胎盘吻合术胎儿镜激光光凝术（FLP）治疗双胎输血综合征（TTTS）的患者发生早产（PTD）的风险因素。

方法

这项回顾性队列研究前瞻性分析并记录了一组接受FLP治疗TTTS的患者的围手术期数据，使用Cox比例风险回归模型确定PTD的围手术期风险因素。

结果

在纳入的304例患者中，26例（8.6%）在FLP后4周内分娩。FLP后4周内分娩的独立预测因素为PTD病史（风险比[HR]：5.91，95%置信区间[CI]：1.21 - 28.82，p = 0.03）、孕中期阴道出血（HR：6.62，95% CI：1.76 - 24.90，p < 0.01）和羊水减量≥1715 mL（HR：3.16，95% CI：1.11 - 9.05，p < 0.03）。