Management of short cervix in twin-to-twin transfusion syndrome: a role for pessary placement following fetoscopic laser surgery?

Bartin, R.; Peralta, Cleisson Fábio Andrioli; Horak, A. R.; Costa, Karina Jorge Rodrigues da; Colmant, C.; Stirnemann, J.; Ville, Y.

doi:10.1016/j.ajog.2023.07.014

American Journal of Obstetrics and Gynecology

2024

DOI: 10.1016/j.ajog.2023.07.014

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Management of short cervix in twin-to-twin transfusion syndrome: a role for pessary placement following fetoscopic laser surgery?

R. Bartin

Cleisson Fábio Andrioli Peralta

A. R. Horak

et al.

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2024

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Prevention of preterm birth in twin-to-twin transfusion syndrome: a systematic review and network meta-analysis

Provinciatto,

Barbalho,

Crosara

et al. 2024

Journal of Perinatal Medicine

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Objectives We aimed to perform a systematic review and network meta-analysis to evaluate the preventive strategies for preterm birth in twin-to-twin transfusion syndrome. Methods PubMed, Embase and Cochrane Central were searched from inception to December 2023 with no filters. Additionally, the reference lists of the included studies were manually examined to identify any supplementary studies. We selected randomized controlled trials and cohorts comparing interventions to prevent preterm birth in twin pregnancies complicated by twin-to-twin transfusion syndrome. A random-effects frequentist network meta-analysis was performed using RStudio version 4.3.1. Randomized controlled trials and cohorts were assessed respectively using the Risk of Bias in Non-randomized Studies of interventions tool and Cochrane Collaboration’s tool for assessing risk of bias in randomized trials. Results In this systematic review and meta-analysis, we included eight studies comprising a total of 719 patients. Compared with expectant management, cerclage stood out as the only intervention associated with an increase in the survival of at least one twin (risk ratio 1.12; 95 % confidence interval 1.01–1.23). Our subgroup analysis based on different thresholds for short cervix demonstrated a significant reduction in the risk of preterm birth before 32 weeks with ultrasound-indicated cerclage using a 15 mm criterion (risk ratio 0.65; 95 % confidence interval 0.47–0.92). Conclusions Our study suggests the potential benefit of cerclage as a preventive strategy for preterm birth in pregnancies complicated by twin-to-twin transfusion syndrome. These findings highlight the necessity for further investigation to corroborate our results and address the optimal threshold for ultrasound-indicated cerclage.

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Prevention of preterm birth in twin-to-twin transfusion syndrome: a systematic review and network meta-analysis

Provinciatto,

Barbalho,

Crosara

et al. 2024

Journal of Perinatal Medicine

View full text Add to dashboard Cite

show abstract

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Management of short cervix in twin-to-twin transfusion syndrome: a role for pessary placement following fetoscopic laser surgery?

Cited by 1 publication

References 37 publications

Prevention of preterm birth in twin-to-twin transfusion syndrome: a systematic review and network meta-analysis

Prevention of preterm birth in twin-to-twin transfusion syndrome: a systematic review and network meta-analysis

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