Timing of delivery following selective laser photocoagulation for twin-to-twin transfusion syndrome

被引：22

作者：

Stirnemann, Julien J. ^{[1
,2
]}

Quibel, Thibault ^{[1
]}

Essaoui, Mohammed ^{[1
]}

Salomon, Laurent J. ^{[1
]}

Bussieres, Laurence ^{[1
,3
]}

Ville, Yves ^{[1
]}

机构：

[1] Univ Paris 05, GHU Necker Enfants Malad, Dept Obstet & Maternal Fetal Med, Paris, France

[2] Univ Paris 05, CNRS, MAP5, Lab Appl Math & Stat,UMR 8145, Paris, France

[3] Univ Paris Ouest, Hop Ambroise Pare, Dept Clin Res, Paris, France

来源：

AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY | 2012年 / 207卷 / 02期

关键词：

monochorionic; percutaneous photocoagulation; preterm birth; prospective risk; PROSPECTIVE RISK; FETAL-DEATH; ANASTOMOSES; COAGULATION; MORBIDITY;

D O I：

10.1016/j.ajog.2012.06.042

中图分类号：

R71 [妇产科学];

学科分类号：

100211 ;

摘要：

OBJECTIVE: We sought to compare intrauterine risks with postnatal outcome in monochorionic pregnancies operated by fetoscopic laser surgery for twin-to-twin transfusion syndrome. STUDY DESIGN: A cohort of 602 consecutive cases was analyzed. Unexpected prenatal adverse events were identified when a fatal or potentially fatal event occurred that could have been avoided by timely delivery. RESULTS: The prospective risk of an unexpected adverse event dropped from 16.8% (95% confidence interval [CI], 13.6-20.5%) to 0% (95% CI, 0-11%) between 26-36 weeks. At 32 weeks, the residual risk was 1 in 17 (95% CI, 1/28-1/11). The perinatal rate of death or severe brain lesions dropped from 35% (25-47%) in infants delivered at 26-28 weeks down to 3% (1-6%) at 34-36 weeks. CONCLUSION: Our results did not identify an optimal cut-off for elective preterm delivery in laser-operated twin-to-twin transfusion syndrome. Perinatal morbidity appears low from >32 weeks and the decision for elective delivery should be based upon medical history, parental demand, and expert assessment.

引用

页码：127.e1 / 127.e6

页数：6