手术时羊膜腔内灌注量与双胎输血综合征潜伏期及分娩时间的关系。

Association of amnioinfusion volume at the time of surgery for twin-twin transfusion syndrome and latency to delivery.

机构信息

Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.

Fetal Care Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.

出版信息

Prenat Diagn. 2023 Aug;43(9):1239-1246. doi: 10.1002/pd.6415. Epub 2023 Aug 8.

DOI:10.1002/pd.6415

PMID:37553727

Abstract

OBJECTIVE

To evaluate the impact of amnioinfusion and other peri-operative factors on pregnancy outcomes in the setting of Twin-twin transfusion syndrome (TTTS) treated via fetoscopic laser photocoagulation (FLP).

METHODS

Retrospective study of TTTS treated via FLP from 2010 to 2019. Pregnancies were grouped by amnioinfusion volume during FLP (<1 L vs. ≥1 L). The primary outcome was latency from surgery to delivery. An amnioinfusion statistic (AIstat) was created for each surgery based on the volume of fluid infused and removed and the preoperative deepest vertical pocket. Regression analysis was planned to assess the association of AIstat with latency.

RESULTS

Patients with amnioinfusion of ≥1 L at the time of FLP had decreased latency from surgery to delivery (61 ± 29.4 vs. 73 ± 28.8 days with amnioinfusion <1 L, p < 0.001) and increased preterm prelabor rupture of membranes (PPROM) <34 weeks (44.7% vs. 33.5%, p = 0.042). Amnioinfusion ≥1 L was associated with an increased risk of delivery <32 weeks (aRR 2.6, 95% CI 1.5-4.5), 30 weeks (aRR 2.4, 95% CI 1.5-3.8), and 28 weeks (aRR 1.9, 95% CI 1.1-2.3). Cox-proportional regression revealed that AIstat was inversely associated with latency (HR 1.1, 95% CI 1.1-1.2).

CONCLUSION

Amnioinfusion ≥1 L during FLP was associated with decreased latency after surgery and increased PPROM <34 weeks.

摘要

目的

评估羊膜腔灌注和其他围手术期因素对接受胎儿镜激光凝固术（FLP）治疗的双胎输血综合征（TTTS）患者妊娠结局的影响。

方法

回顾性研究 2010 年至 2019 年期间接受 FLP 治疗的 TTTS 患者。根据 FLP 期间的羊膜腔灌注量（<1 L 与≥1 L）将妊娠分组。主要结局是从手术到分娩的潜伏期。根据灌注和去除的液体量以及术前最深垂直囊袋，为每次手术创建羊膜腔灌注统计量（AIstat）。计划进行回归分析，以评估 AIstat 与潜伏期的相关性。

结果

FLP 时羊膜腔灌注量≥1 L 的患者，从手术到分娩的潜伏期缩短（61±29.4 天与羊膜腔灌注量<1 L 的 73±28.8 天相比，p<0.001），且未足月胎膜早破（PPROM）<34 周的发生率增加（44.7%与 33.5%，p=0.042）。羊膜腔灌注量≥1 L 与<32 周（aRR 2.6，95%CI 1.5-4.5）、30 周（aRR 2.4，95%CI 1.5-3.8）和 28 周（aRR 1.9，95%CI 1.1-2.3）的分娩风险增加相关。Cox 比例风险回归显示，AIstat 与潜伏期呈负相关（HR 1.1，95%CI 1.1-1.2）。