Absorbable gelatin plug does not prevent iatrogenic preterm premature rupture of membranes after fetoscopic laser surgery for twin–twin transfusion syndrome

Papanna, Ramesha; Mann, Lovepreet K.; Moise, K. J.; Johnson, Anthony; Moise, Kenneth J.

doi:10.1002/uog.12487

Cited by 26 publications

(30 citation statements)

References 21 publications

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“…PROM is the most common iatrogenic complication following fetoscopic laser treatment for TTTS [9]. The overall rate of PROM reported in our study (25.9%) is consistent with the range of PROM outcomes reported recently from a single-center series using different fetoscopic instrumentation [16,17,20,21,22,23,24]. Cervical length, and not the fetoscopic technique, was demonstrated in our large multicenter study to be associated with PROM <4 weeks.…”

Section: Discussionsupporting

confidence: 79%

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The Impact of Entry Technique and Access Diameter on Prelabour Rupture of Membranes Following Primary Fetoscopic Laser Treatment for Twin-Twin Transfusion Syndrome

et al. 2016

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Objective: To evaluate the impact of entry method and access diameter at fetoscopic surgery for twin-twin transfusion syndrome in twin pregnancies with at least one survivor. The outcomes evaluated were prelabour rupture of membranes (PROM) and birth <4 weeks, preterm birth (PTB) <28 weeks, and latency to birth. Methods: A retrospective analysis of prospectively collected data of consecutive laser procedures from 6 centers was performed. Three entry methods (sheath + trocar; cannula + trocar; cannula + Seldinger) and 6 access diameters (2.3, 3.0, 3.3, 3.5, 3.8, 4.0 mm) were used. Exclusion criteria were subsequent invasive interventions, termination of pregnancy or double fetal death after laser. Multivariate analysis was performed to determine risk factors for the study outcomes. Results: Six hundred seventy three fetoscopic laser cases were analyzed. The use of different entry methods and access diameters did not affect PROM or birth <4 weeks, or latency from laser to birth. Access diameter was associated with PTB <28 weeks. Cervical length was associated with PROM and birth <4 weeks, and latency from laser to birth. Conclusion: Instrument choice at fetoscopic laser procedures did not affect outcomes <4 weeks. Access diameter may affect the likelihood for PTB <28 weeks. Cervical length is critically associated with obstetrical outcomes following laser surgery.

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Section: Discussionsupporting

confidence: 79%

“…Few studies have evaluated the factors associated with PROM and PTB following fetoscopic laser [5,9,13,14,16,17,18,19,20]. No prior study has attempted to compare outcomes against different invasive fetoscopic techniques, which may contribute to complication rates.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Entry Technique and Access Diameter on Prelabour Rupture of Membranes Following Primary Fetoscopic Laser Treatment for Twin-Twin Transfusion Syndrome

et al. 2016

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“…His cases were all performed after July 2012. This result compares favorably with that reported by the experienced operators in Moise's group (75%) 8 . Given that our study was not a randomized controlled trial, and that the two techniques were employed sequentially in our study, the question is still valid, and is one that, hopefully, will be answered soon by the randomized controlled trial that is underway.…”

Section: Replysupporting

confidence: 80%

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Ruano

Rodó

Peiró

et al. 2014

Ultrasound in Obstet & Gyne

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“…The use of a chorioamnion plug has shown promise in animal studies [15,16] and some clinical studies [17], but has not been shown to be universally successful in retrospective human studies [5,18]. Chorioamnion separation has also been shown to increase the rate of iPPROM, from 23 to 74% (relative risk 3.2, 95% CI 1.9-4.4) [19].…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic Preterm Premature Rupture of Membranes after Fetoscopic Laser Ablative Surgery

et al. 2014

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Introduction: To describe the incidence and risk factors for iatrogenic premature preterm rupture of membranes (iPPROM) after fetoscopic laser surgery for the twin-to-twin-transfusion syndrome. Materials and Methods: This is a retrospective review of all patients who have undergone fetoscopic laser surgery at a single fetal treatment center since 2000. We defined iPPROM as spontaneous rupture of membranes before the onset of labor prior to 34 weeks of gestation. The iPPROM cohort was compared to the cohort without iPPROM for several preoperative, operative, and delivery characteristics. Results: Ninety-two consecutive patients were reviewed. The overall rate of iPPROM was 18.5% (n = 17). The rates of iPPROM within 1 and 4 weeks were 5.4 and 10.9%, respectively. The median interval from surgery to delivery was significantly shorter in the iPPROM group (21 vs. 62 days, p = 0.01). The mean gestational age at delivery (27.0 vs. 31.1 weeks, p = 0.02) was lower in the iPPROM group. No other characteristics studied differed significantly between the groups. Discussion: The incidence of iPPROM was substantially lower than in recent multicenter reports; however, no risk factors of iPPROM could be identified. Whether this is related to variations in surgical or anesthetic management will require further investigation.

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Absorbable gelatin plug does not prevent iatrogenic preterm premature rupture of membranes after fetoscopic laser surgery for twin–twin transfusion syndrome

Abstract: Objective Despite fetoscopic laser ablation (FLA)

Cited by 26 publications

References 21 publications

The Impact of Entry Technique and Access Diameter on Prelabour Rupture of Membranes Following Primary Fetoscopic Laser Treatment for Twin-Twin Transfusion Syndrome

The Impact of Entry Technique and Access Diameter on Prelabour Rupture of Membranes Following Primary Fetoscopic Laser Treatment for Twin-Twin Transfusion Syndrome

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Iatrogenic Preterm Premature Rupture of Membranes after Fetoscopic Laser Ablative Surgery

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