Iatrogenic Preterm Premature Rupture of Membranes after Fetoscopic Laser Ablative Surgery

Abstract

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.

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

“…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.…”

“…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.…”

“…In addition, differences in case selection exist between centers. For instance, the cut off for polyhydramnios defining TTTS in the Australia [12] and the United States [11,20] is 8 cm, whereas in Europe [3,8,10] from 20 weeks it is 10 cm. One center excluded cases with a short cervix, a known predictor of poor outcome [13,14].…”

“…Beck et al [19] reported considerable heterogeneity in the reporting of PROM rates following placental laser ablation for TTTS cases. A recent retrospective study of PROM before the onset of labour from a single center reported on rates within 1 (5.4%) and 4 (10.9%) weeks, and before 34 weeks (18.5%) [20]. PROM is the most common iatrogenic complication following fetoscopic laser treatment for TTTS [9].…”

Body wall force sensor for simulated minimally invasive surgery: Application to fetal surgery

“…at the incision. Such stresses might induce iatrogenic premature preterm rupture of the membrane (iPPROM) which might cause premature birth, hence reducing drastically the survival rate of the twins [6].…”