Document Detail


Fetoscopic laser coagulation for severe twin-to-twin transfusion syndrome: factors influencing perinatal outcome, learning curve of the procedure and lessons for new centres.
MedLine Citation:
PMID:  20670301     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE:   To evaluate the effects of operator experience on perinatal outcome in a single centre.
DESIGN:   Prospective consecutive cohort study.
SETTING:   Regional tertiary referral Fetal Medicine Centre in the UK.
POPULATION:   Pregnant women with monochorionic twin pregnancies complicated by severe twin-to-twin transfusion syndrome (TTTS) (at ≤26 completed weeks of gestatiuon) treated by fetoscopic laser coagulation (FLC) between October 2004 and November 2009.
METHODS:   Pregnancy characteristics and outcomes were collected. Logistic regression analysis was employed to determine the effect of a priori defined variables on outcome.
MAIN OUTCOME MEASURE:   Perinatal survival (survival to 28 days or beyond) for one or more twins.
RESULTS:   There were 164 consecutive sets of monochorionic twins. The median gestational age (GA) at FLC was 20.4 weeks (interquartile range 18-22.1 weeks), the median interval from FLC to delivery was 88.5 days (interquartile range 53-101 days) and the median GA at delivery was 33.2 weeks (interquartile range 29.7-34.9 weeks). The overall survival was 62%; perinatal survival of one or more twins was 85%. These outcomes improved after about 61 procedures were performed, and after about 3.4 years of experience. Univariate logistic regression analysis indicated that Quintero stage-IV disease decreased (OR 0.26; 95% CI 0.10-0.69) and prolongation of GA at delivery increased the survival of the twins (OR 1.34; 95% CI 1.12-1.60) (P < 0.01). Increasing experience of the procedure by operator led to a significant increase in perinatal survival (P < 0.01; OR 4.59; 95% CI 1.84-11.44). Multivariate logistic regression analysis indicated that only GA at delivery increased survival overall (OR 1.34; 95% CI 1.12-1.60; P = 0.01).
CONCLUSIONS:   These data indicate that both relatively large numbers treated and experience with FLC minimises any adverse outcome in monochorionic pregnancies with severe TTTS.
Authors:
R K Morris; T J Selman; A Harbidge; W I Martin; M D Kilby
Publication Detail:
Type:  Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  BJOG : an international journal of obstetrics and gynaecology     Volume:  117     ISSN:  1471-0528     ISO Abbreviation:  BJOG     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-15     Completed Date:  2010-12-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100935741     Medline TA:  BJOG     Country:  England    
Other Details:
Languages:  eng     Pagination:  1350-7     Citation Subset:  AIM; IM    
Affiliation:
School of Clinical and Experimental Medicine, University of Birmingham, Edgbaston, Birmingham, UK.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Female
Fetal Membranes, Premature Rupture / etiology
Fetofetal Transfusion / mortality,  surgery*
Fetoscopy / methods*
Humans
Laser Coagulation / methods*
Learning Curve
Perinatal Mortality
Postoperative Complications / etiology
Pregnancy
Pregnancy Outcome
Prenatal Care / methods*
Prospective Studies
Twins, Monozygotic
Young Adult
Grant Support
ID/Acronym/Agency:
//Medical Research Council

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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