Risk Factors and Outcomes Following Septostomy during Fetoscopic Surgery for Twin-to-Twin Transfusion Syndrome
Fetoscopic laser photocoagulation (FLP) of placental anastomoses is the preferred treatment for twin-to-twin transfusion syndrome (TTTS). Iatrogenic septostomy (IOS) during FLP is associated with increased risk of neonatal morbidity and mortality. We sought to identify risk factors for IOS and quant...
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MDPI AG
2021-08-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/10/16/3693 |
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| author | Clifton O. Brock Eric P. Bergh Edgar A. Hernandez-Andrade Rodrigo Ruano Anthony Johnson Ramesha Papanna |
| author_facet | Clifton O. Brock Eric P. Bergh Edgar A. Hernandez-Andrade Rodrigo Ruano Anthony Johnson Ramesha Papanna |
| author_sort | Clifton O. Brock |
| collection | DOAJ |
| description | Fetoscopic laser photocoagulation (FLP) of placental anastomoses is the preferred treatment for twin-to-twin transfusion syndrome (TTTS). Iatrogenic septostomy (IOS) during FLP is associated with increased risk of neonatal morbidity and mortality. We sought to identify risk factors for IOS and quantify the resultant outcomes. This is a secondary analysis of prospectively collected cases of TTTS in monochorionic diamniotic twins following FLP at a single center. Pre-operative ultrasound characteristics and operative technique (i.e., cannula size, total energy used) were compared between cases with vs. without IOS. Pregnancy and neonatal outcomes were also compared. Of 475 patients that had FLP, 33 (7%) were complicated by IOS. There was no association between operative technique and IOS. IOS was more common with later diagnosis, but less likely when selective fetal growth restriction (sFGR) was present. Survival was similar between groups (76% vs. 76% dual survivors, <i>p</i> = 0.95); however, IOS was associated with earlier delivery (29.7 vs. 32.0 wks, <i>p</i> < 0.01) and greater composite neonatal morbidity (25% vs. 8% in both twins, <i>p</i> = 0.02). Risks of IOS at greater gestational ages without sFGR may be related to a larger collapsed intervening membrane area and the resulting increased risk of puncture on entry. |
| first_indexed | 2024-03-10T08:42:11Z |
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| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T08:42:11Z |
| publishDate | 2021-08-01 |
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| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-a8c990d78ef1420681e13dd327a151352023-11-22T08:12:09ZengMDPI AGJournal of Clinical Medicine2077-03832021-08-011016369310.3390/jcm10163693Risk Factors and Outcomes Following Septostomy during Fetoscopic Surgery for Twin-to-Twin Transfusion SyndromeClifton O. Brock0Eric P. Bergh1Edgar A. Hernandez-Andrade2Rodrigo Ruano3Anthony Johnson4Ramesha Papanna5Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX 77030, USADepartment of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX 77030, USADepartment of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX 77030, USADepartment of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX 77030, USADepartment of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX 77030, USADepartment of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX 77030, USAFetoscopic laser photocoagulation (FLP) of placental anastomoses is the preferred treatment for twin-to-twin transfusion syndrome (TTTS). Iatrogenic septostomy (IOS) during FLP is associated with increased risk of neonatal morbidity and mortality. We sought to identify risk factors for IOS and quantify the resultant outcomes. This is a secondary analysis of prospectively collected cases of TTTS in monochorionic diamniotic twins following FLP at a single center. Pre-operative ultrasound characteristics and operative technique (i.e., cannula size, total energy used) were compared between cases with vs. without IOS. Pregnancy and neonatal outcomes were also compared. Of 475 patients that had FLP, 33 (7%) were complicated by IOS. There was no association between operative technique and IOS. IOS was more common with later diagnosis, but less likely when selective fetal growth restriction (sFGR) was present. Survival was similar between groups (76% vs. 76% dual survivors, <i>p</i> = 0.95); however, IOS was associated with earlier delivery (29.7 vs. 32.0 wks, <i>p</i> < 0.01) and greater composite neonatal morbidity (25% vs. 8% in both twins, <i>p</i> = 0.02). Risks of IOS at greater gestational ages without sFGR may be related to a larger collapsed intervening membrane area and the resulting increased risk of puncture on entry.https://www.mdpi.com/2077-0383/10/16/3693prenatal ultrasoundfetal medicinefetal surgeryplacental laser surgerymonochorionic diamniotic twinstwin-to-twin transfusion syndrome |
| spellingShingle | Clifton O. Brock Eric P. Bergh Edgar A. Hernandez-Andrade Rodrigo Ruano Anthony Johnson Ramesha Papanna Risk Factors and Outcomes Following Septostomy during Fetoscopic Surgery for Twin-to-Twin Transfusion Syndrome Journal of Clinical Medicine prenatal ultrasound fetal medicine fetal surgery placental laser surgery monochorionic diamniotic twins twin-to-twin transfusion syndrome |
| title | Risk Factors and Outcomes Following Septostomy during Fetoscopic Surgery for Twin-to-Twin Transfusion Syndrome |
| title_full | Risk Factors and Outcomes Following Septostomy during Fetoscopic Surgery for Twin-to-Twin Transfusion Syndrome |
| title_fullStr | Risk Factors and Outcomes Following Septostomy during Fetoscopic Surgery for Twin-to-Twin Transfusion Syndrome |
| title_full_unstemmed | Risk Factors and Outcomes Following Septostomy during Fetoscopic Surgery for Twin-to-Twin Transfusion Syndrome |
| title_short | Risk Factors and Outcomes Following Septostomy during Fetoscopic Surgery for Twin-to-Twin Transfusion Syndrome |
| title_sort | risk factors and outcomes following septostomy during fetoscopic surgery for twin to twin transfusion syndrome |
| topic | prenatal ultrasound fetal medicine fetal surgery placental laser surgery monochorionic diamniotic twins twin-to-twin transfusion syndrome |
| url | https://www.mdpi.com/2077-0383/10/16/3693 |
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