| Fetoscopic laser coagulation for severe twin-to-twin transfusion syndrome: factors influencing perinatal outcome, learning curve of the procedure and lessons for new centres. | |
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MedLine Citation:
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PMID: 20670301 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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R K Morris; T J Selman; A Harbidge; W I Martin; M D Kilby |
Publication Detail:
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Type: Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: BJOG : an international journal of obstetrics and gynaecology Volume: 117 ISSN: 1471-0528 ISO Abbreviation: BJOG Publication Date: 2010 Oct |
Date Detail:
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Created Date: 2010-09-15 Completed Date: 2010-12-22 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 100935741 Medline TA: BJOG Country: England |
Other Details:
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Languages: eng Pagination: 1350-7 Citation Subset: AIM; IM |
Affiliation:
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School of Clinical and Experimental Medicine, University of Birmingham, Edgbaston, Birmingham, UK. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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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:
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//Medical Research Council |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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