Chorioamniotic membrane separation after fetoscopy in monochorionic twin pregnancy: incidence and impact on perinatal outcome

Ortiz, JU; Eixarch, Elisenda; Peguero, Anna; Lobmaier, Silvia M.; Bennásar, M.; Martínez, Josep M.; Gratacós, E.

doi:10.1002/uog.14936

Cited by 44 publications

(54 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In other words, the intervention during earlier gestations often caused CMS, which is consistent with the past report by Ortiz et al [7] . The only independent risk factor of CMS was performing the procedure before 20 weeks in this study.…”

Section: Discussionsupporting

confidence: 81%

“…CMS following FLP occurred in 12.7% of cases in this study, whereas other studies have reported 19.6-20.7% [7][8][9] ( Table 2 ). The factor leading to this lower incidence remains to be accounted for, but we speculate that the differences in GA at surgery (proportion of surgery before 18 weeks was 40% in Ortiz et al [7] compared with 11.9% in the present study), type of surgery (including cord occlusion or not), use of tocolysis, and operation procedure affected the lower incidence.…”

Section: Discussioncontrasting

confidence: 54%

“…This result is consistent with that in the report by Egawa et al [8] . The obvious reason for the discrepancy in the perinatal outcome is uncertain, but we consider that later GA at surgery played a role in improvement of perinatal outcomes; Ortiz et al [7] reported an earlier GA in the CMS group than that of the present study (18 vs. 19.3 weeks).…”

Section: Discussioncontrasting

confidence: 52%

“…In this study, higher incidence of preterm PROM before 32 weeks of GA was found, which is consistent with the previous reports ( Table 2 ). Although CMS was considered as a risk factor of adverse perinatal outcome [7,9] , none of the miscarriage, preterm delivery, or fetal survival rate was not necessarily related to postoperative CMS in this study. This result is consistent with that in the report by Egawa et al [8] .…”

Section: Discussionmentioning

confidence: 92%

“…Almost all morbid CMS are induced by medical intervention, such as amniocentesis, open fetal surgery, and FLP. Only a few reports show that the incidence of CMS following FLP was approximately 20%, and postoperative CMS might increase the risk of preterm PROM, preterm delivery, and fetal demise [7][8][9] .…”

mentioning

confidence: 99%

See 4 more Smart Citations

Chorioamniotic Membrane Separation after Fetoscopic Laser Photocoagulation

Takano

Nakata²,

Murata³

et al. 2017

Fetal Diagn Ther

View full text Add to dashboard Cite

Introduction: This study aimed to investigate the risk factors, incidence, and influence on the perinatal outcome of chorioamniotic membrane separation (CMS) after fetoscopic laser photocoagulation (FLP). Material and Methods: This retrospective study included 312 women who underwent FLP for twin-to-twin transfusion syndrome (TTTS). Clinical records were used to review obstetrical examinations, complications, operative data, ultrasonographic findings, and perinatal and neonatal follow-up data in all patients. Results: A total of 260 cases of TTTS were analyzed. The incidence of CMS was 12.7% (33 cases). The only independent risk factor of CMS was performing FLP before 20 weeks of gestational age (GA) (odds ratio = 3.38 [1.44-7.93], p = 0.005). Concerning perinatal outcome, CMS was only related with increased risk of premature rupture of membranes (PROM) before 32 weeks (33.3 vs. 13.9%, p = 0.005), with no differences in GA at delivery and survival rate. Discussion: In our cohort, the incidence of CMS after FLP was approximately 13%, with surgery before 20 weeks being the only risk factor identified. Although in our population CMS did not worsen perinatal outcome in terms of preterm delivery or survival, the preterm PROM rate was increased and this should be considered for the patients' management.

show abstract

Section: Discussionsupporting

confidence: 81%

Section: Discussioncontrasting

confidence: 54%

Section: Discussioncontrasting

confidence: 52%

Section: Discussionmentioning

confidence: 92%

mentioning

confidence: 99%

See 3 more Smart Citations

Chorioamniotic Membrane Separation after Fetoscopic Laser Photocoagulation

Takano

Nakata²,

Murata³

et al. 2017

Fetal Diagn Ther

View full text Add to dashboard Cite

show abstract

Early‐onset twin–twin transfusion syndrome: Case series and systematic review

Mylrea‐Foley

Shaw

Harikumar

et al. 2019

Australas J Ultrason Med

View full text Add to dashboard Cite

Introduction: Data on the outcomes of early-onset twin-twin transfusion syndrome (TTTS), diagnosed before 18 weeks gestational age (GA), are sparse. We aimed to review the diagnosis, management and outcomes of early-onset TTTS. Material and methods: Pregnancy records at a single referral unit 2010-6 were reviewed. In early-onset TTTS cases, data for pregnancy characteristics, interventions and outcomes were collected. PubMed and Scopus databases were searched for studies including pregnant women with early-onset TTTS. The primary outcome measure was livebirths. Results: Case series: 58 cases of early-onset TTTS 2010-6, with full outcome data in 44. Diagnostic criteria were variable. Median GA at intervention was 17 +4 (range 15 +0 -28 +1 ); 67% of patients had laser therapy (39/58). Overall survival: 60% (53/88). At least one livebirth: 86% (38/44), Two livebirths: 34% (15/44); No survivors: 14% (6/44). GA at delivery was 32 +1.5 (range 16 +2 -37 +4 ). Systematic review: 16 studies included (n = 171 pregnancies). Diagnostic criteria varied widely: 79% of studies used Quintero staging. Most offered laser (89%) at median 17 +0 weeks (range 16 +0 -21 +6 ). GA at delivery was 23 +0 -39 +5 weeks. Overall survival: 69% (129/186). At least one livebirth: 74% (127/171). Two livebirths: 59% (55/93). No survivors: 26% (44/171). Conclusions: In comparison with the commonly accepted overall survival for TTTS treated after 18 weeks of 60-90%, outcomes in early-onset TTTS were at the lower bound of this range. Gestational age at intervention is similar to that of later onset TTTS, indicating a lack of therapeutic options when a diagnosis is made before 18 weeks.

show abstract

Pregnancy outcomes associated with chorioamnion membrane separation severity following fetoscopic laser surgery for twin‐twin transfusion syndrome

et al. 2020

View full text Add to dashboard Cite

ObjectiveWe tested the hypothesis that increasing severity of chorioamnion membrane separation (CAS) after fetoscopic laser surgery (FLS) for twin‐twin transfusion syndrome (TTTS) is associated with worse pregnancy outcomes.MethodsProspective cohort of patients undergoing FLS for TTTS between 2011 and 2018. CAS was defined as separation of fetal membranes from the uterine wall on post‐operative ultrasound. Patient groups were defined: Group 1: No CAS; Group 2: CAS lower than 50th centile; Group 3: CAS upper than 50th centile or complete CAS. Comparative analysis was performed.ResultsOf 387 patients meeting inclusion criteria, 29 (7.5%) had CAS (median 9.8 mm [4.9‐30.8 mm]). Group 1 patients were more likely to undergo FLS at later gestational age, had increased recipient maximum vertical pocket, and higher amnioreduction volume than Group 3. Group 3 had higher rates of preterm premature rupture of membrane, delivered earlier and were more likely to terminate than Group 1. Group 2 had fewer neonatal survivors than Group 1. Survival analysis for gestational age at delivery and Cox proportional hazards model indicated increased risk for early delivery in Groups 2 and 3 compared with Group 1.ConclusionsPatients with CAS ≥9.8 mm or complete CAS after FLS for TTTS had worse obstetric and neonatal outcomes.

show abstract

Chorioamniotic membrane separation after fetoscopy in monochorionic twin pregnancy: incidence and impact on perinatal outcome

Abstract: Objective To evaluate the incidence of chorioamniotic membrane separation (CMS) after fetoscopy in monochorionic diamniotic (MCDA) twins and its impact on pregnancy outcome. Methods

Cited by 44 publications

References 31 publications

Chorioamniotic Membrane Separation after Fetoscopic Laser Photocoagulation

Chorioamniotic Membrane Separation after Fetoscopic Laser Photocoagulation

Early‐onset twin–twin transfusion syndrome: Case series and systematic review

Pregnancy outcomes associated with chorioamnion membrane separation severity following fetoscopic laser surgery for twin‐twin transfusion syndrome

Contact Info

Product

Resources

About