Perinatal outcomes following fetoscopic laser surgery for early twin‐to‐twin transfusion syndrome: Systematic review and meta‐analysis

dc.contributor.authorMustafa, Hiba J.
dc.contributor.authorAghajani, Faezeh
dc.contributor.authorPatrick, Elise
dc.contributor.authorBaerz, Maryam M.
dc.contributor.authorArias‐Sánchez, Pedro
dc.contributor.authorKhalil, Asma
dc.contributor.departmentObstetrics and Gynecology, School of Medicine
dc.date.accessioned2024-07-11T09:16:44Z
dc.date.available2024-07-11T09:16:44Z
dc.date.issued2024
dc.description.abstractIntroduction: Our objective was to investigate outcomes in twin-to-twin transfusion syndrome (TTTS) treated with fetoscopic laser surgery (FLS) at <18 weeks vs ≥18 weeks, and to conduct subgroup analysis of TTTS with FLS at <16 weeks vs 16-18 weeks. Material and methods: PubMed, Scopus and Web of Science were searched systematically from inception until May 2023. Primary outcome was survival, and secondary outcomes included preterm premature rupture of membranes (PPROM), preterm birth and gestational age (GA) at delivery. Results: Nine studies encompassing 1691 TTTS pregnancies were included. TTTS stage III was significantly more common in TTTS pregnancies treated with FLS at <18 weeks (odds ratio [ OR ] 2.84, 95% confidence interval [ CI ] 1.24-6.54), and procedure duration was shorter at <18 weeks (MD -5.27 minutes, 95% CI -9.19 to -1.34). GA at delivery was significantly earlier in TTTS pregnancies treated with FLS at <18 weeks (MD -3.12 weeks, 95% CI -6.11 to -0.13). There were no significant differences in outcomes, including PPROM, PPROM at <7 days post-FLS, preterm birth at <28 and <32 weeks, delivery at <7 days post-FLS, and survival outcomes, including fetal demise, live birth and neonatal survival. Similarly, TTTS stage III was more common in TTTS with FLS at <16 weeks than at 16-18 weeks (OR 2.95, 95% CI 1.62-5.35), with no significant differences in the aforementioned outcomes. Conclusions: In early TTTS treated with FLS, outcomes were comparable between those treated at <18 weeks compared with ≥18 weeks except for GA at delivery, which was 3 weeks earlier. In the subset treated at <16 weeks vs 16-18 weeks, the procedure was feasible without an increased risk of very early preterm birth or perinatal mortality.
dc.eprint.versionFinal published version
dc.identifier.citationMustafa HJ, Aghajani F, Patrick E, Baerz MM, Arias-Sánchez P, Khalil A. Perinatal outcomes following fetoscopic laser surgery for early twin-to-twin transfusion syndrome: Systematic review and meta-analysis. Acta Obstet Gynecol Scand. 2024;103(5):824-831. doi:10.1111/aogs.14806
dc.identifier.urihttps://hdl.handle.net/1805/42105
dc.language.isoen_US
dc.publisherWiley
dc.relation.isversionof10.1111/aogs.14806
dc.relation.journalActa Obstetricia et Gynecologica Scandinavica
dc.rightsAttribution-NonCommercial 4.0 Internationalen
dc.rights.urihttp://creativecommons.org/licenses/by-nc/4.0/
dc.sourcePMC
dc.subjectFetoscopy
dc.subjectLaser
dc.subjectMeta‐analysis
dc.subjectMonochorionic
dc.subjectSystematic review
dc.subjectTwin
dc.subjectTwin‐to‐twin transfusion
dc.titlePerinatal outcomes following fetoscopic laser surgery for early twin‐to‐twin transfusion syndrome: Systematic review and meta‐analysis
dc.typeArticle
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