Cerclage for cervical shortening at fetoscopic laser photocoagulation in twin-twin transfusion syndrome

Papanna, Ramesha; Habli, Mounira; Baschat, Ahmet; Bebbington, Michael; Mann, Lovepreet K.; Johnson, Anthony; Ryan, Greg; Walker, M.; Lewis, David; Harman, Christopher; Crombleholme, Timothy M.; Moise, Kenneth J.

doi:10.1016/j.ajog.2012.02.022

Cited by 26 publications

(20 citation statements)

References 8 publications

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“…A preoperative short cervical length was a significant factor in decreasing the gestational age at birth. This adds further support to this association reported in previous studies, irrespective of the placement of a cerclage.…”

Section: Discussionsupporting

confidence: 90%

Risk factors associated with preterm delivery after fetoscopic laser ablation for twin-twin transfusion syndrome

Papanna

Block-Abraham

Mann³

et al. 2014

Ultrasound Obstet Gynecol

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OBJECTIVE Despite improved perinatal survival following fetoscopic laser surgery (FLS) for twin twin transfusion syndrome (TTTS), prematurity remains an important contributor to perinatal mortality and morbidity. The objective of the study was to identify risk factors for complicated preterm delivery after FLS. STUDY DESIGN Retrospective cohort study of prospectively collected data on maternal/fetal demographics and pre-operative, operative and post-operative variables of 459 patients treated in 3 U.S. fetal centers. Multivariate linear regression was performed to identify significant risk factors associated with preterm delivery, which was cross-validated using K-fold method. Multivariate logistic regression was performed to identify risk factors for early vs. late preterm delivery based on median gestational age at delivery of 32 weeks. RESULTS There were significant differences in case selection and outcomes between the centers. After controlling for the center of surgery, a multivariate analysis indicated a lower maternal age at procedure, history of previous prematurity, shortened cervical length, use of amnioinfusion, 12 Fr cannula diameter, lack of a collagen plug placement and iatrogenic preterm premature rupture of membranes (iPPROM) were significantly associated with a lower gestational age at delivery. CONCLUSION Specific fetal/maternal and operative variables are associated with preterm delivery after FLS for the treatment of TTTS. Further studies to modify some of these variables may decrease the perinatal morbidity after laser therapy.

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Section: Discussionsupporting

confidence: 90%

Risk factors associated with preterm delivery after fetoscopic laser ablation for twin-twin transfusion syndrome

Papanna

Block-Abraham

Mann³

et al. 2014

Ultrasound Obstet Gynecol

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show abstract

“… 12 However, this initially encouraging result has been called into question by a recent retrospective review. 13 In our study, MVP preoperatively did not correlate with either latency from procedure to delivery or gestational age at delivery. This may be explained by the effectiveness of laser surgery in resolving the fluid derangements in TTTS and eliminating recurrent polyhydramnios as a contributing factor to uterine distension and subsequent preterm labor.…”

Section: Discussioncontrasting

confidence: 68%

Effect of Cervical Length Recovery after Laser Surgery for Twin-Twin Transfusion Syndrome

Finneran

Temming

Templin³

et al. 2016

AJP Rep

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Objective To evaluate the impact of polyhydramnios on preoperative cervical length and whether cervical length recovery after amnioreduction during selective fetoscopic laser photocoagulation (SFLP) is associated with a greater gestational age at delivery in pregnancies complicated by twin-twin transfusion syndrome (TTTS). Methods Retrospective study of 50 pregnancies complicated by TTTS treated with SFLP between March 2010 and July 2014 at a single center. Preoperative maximum vertical pocket (MVP) was measured along with pre- and postoperative cervical length. A cervical length difference was calculated, with a difference of ± 3 mm considered no change. Results Only 12 (34%) patients showed an increased cervical length after amnioreduction during laser surgery. There was no statistical difference between either negative or positive change in cervical length groups and mean gestational age at delivery (p = 0.82). There also was no correlation between preoperative MVP and preoperative cervical length (p = 0.36) or gestational age at delivery (p = 0.77). However, there was a statistically shorter mean preoperative cervical length in patients who delivered <32 weeks of gestation (3.62 ± 0.66 vs. 4.20 ± 0.85 cm; p = 0.03). Conclusion Severity of polyhydramnios does not correlate with preoperative cervical length, and variability of the cervix postoperatively does not appear to affect gestational age at delivery.

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“…Ever since the first two case series by De Lia et al were reported in 1990 and 1995, 1,2 the perinatal survival rates after fetoscopic laser surgeries for twin-twin transfusion syndrome (TTTS) have continued to improve. [3][4][5][6][7][8][9][10] However, preterm delivery remains the major complication of the procedure and the average gestational age at delivery has remained constant, between 29 and 33 weeks. The next important outcome after live birth is the neurologically intact rate of survival.…”

mentioning

confidence: 99%

“…iPPROM occurring before < 34 weeks of gestation affects 11 to 50% of patients who are undergoing fetoscopic laser surgery. [3][4][5][6][7][8][9][10] Papanna et al 16 showed that iPPROM after fetoscopic laser surgery reduced the pregnancy duration by 2 weeks. The reason for the increased risk for iPPROM after invasive fetal procedures has been attributed to the nonhealing nature of fetal membranes at the site of trocar entry.…”

mentioning

confidence: 99%

The Problem of Preterm Delivery after Laser Surgery

Papanna

2014

Amer J Perinatol

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Preterm birth after fetoscopic laser surgery for twin-twin transfusion continues to be a major challenge despite improved survival rates. The risk factors for the complications have been identified, which include preterm premature rupture of membranes, cervical length shortening, larger cannula diameter, amnioinfusion, complicated procedure, and severe disease. The interventions to prevent preterm birth such as cervical cerclage for short cervix and collagen plug placement have not been successful. Further understanding of the pathophysiology is urgently needed to identify newer methods to prevent preterm birth.

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Cerclage for cervical shortening at fetoscopic laser photocoagulation in twin-twin transfusion syndrome

Cited by 26 publications

References 8 publications

Risk factors associated with preterm delivery after fetoscopic laser ablation for twin-twin transfusion syndrome

Risk factors associated with preterm delivery after fetoscopic laser ablation for twin-twin transfusion syndrome

Effect of Cervical Length Recovery after Laser Surgery for Twin-Twin Transfusion Syndrome

The Problem of Preterm Delivery after Laser Surgery

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