Preterm premature rupture of membranes is a collateral effect of improvement in perinatal outcomes following fetoscopic coagulation of chorionic vessels for twin-twin transfusion syndrome: a retrospective observational study of 1092 cases.
BJOG
; 125(9): 1154-1162, 2018 Aug.
Article
in En
| MEDLINE
| ID: mdl-29380497
ABSTRACT
OBJECTIVES:
Preterm premature rupture of membranes (PPROM) is a leading complication following fetoscopic laser coagulation (FLC) for twin-twin transfusion syndrome (TTTS). Our primary objective was to describe the impact of improvements in surgical technique on survival and rate of PPROM over time. The secondary objective was to assess potential risk factors for PPROM. DESIGN ANDSETTING:
Single-centre retrospective observational study. POPULATION 1092 consecutive cases of TTTS operated by FLC between 2000 and 2016, with a 6.8% rate of loss to follow up.METHODS:
The incidence of PPROM and potential risk factors were analysed using competing risks models. MAIN OUTCOMEMEASURES:
PPROM, neonatal survival and neurological damage at 28 days.RESULTS:
PPROM <32 weeks increased from 15 to 40% between 2000 and 2016 along with an overall improvement of perinataloutcomes:
dual survival rose from 42 to 66% whereas dual losses dropped two-fold, from 19 to 9%. Gestational age at surgery at <17 weeks was a significant risk-factor for PPROM, with an additional risk of 10% within the first week of surgery. Although early PPROM at <20 weeks carried a 56% risk of miscarriage, the occurrence of PPROM at >20 weeks did not affect survival, despite an increase in preterm birth at <32 weeks.CONCLUSIONS:
With significant improvement in perinatal outcomes, possibly related to improvements in surgical technique, postoperative complications have shifted to non-lethal obstetric complications such as PPROM, with rather reassuring postnatal outcomes, despite an increase in preterm birth and, potentially, morbidity. Early surgeries (<17 weeks) are at higher risk of postoperative PPROM. TWEETABLE ABSTRACT Following laser/TTTS, rates of PPROM increased with perinatal survival; surgeries at <17 weeks are at highest risk.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Fetal Membranes, Premature Rupture
/
Laser Coagulation
/
Fetofetal Transfusion
/
Fetoscopy
Type of study:
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Female
/
Humans
/
Pregnancy
Language:
En
Journal:
BJOG
Year:
2018
Document type:
Article