Twin-to-twin transfusion syndrome and coronavirus disease 2019: impact on diagnosis, referral, eligibility for fetoscopic laser therapy, and outcomesAJOG Global Reports at a Glance
BACKGROUND: Because of the progressive nature of twin-to-twin transfusion syndrome, difficulties in healthcare access during the COVID-19 pandemic may lead to delayed diagnosis and referral to fetal surgery centers, which may have repercussions on outcomes. OBJECTIVE: This study aimed to assess the...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-02-01
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| Series: | AJOG Global Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666577821000381 |
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| author | Hugo López-Briones, MD Rosa Villalobos-Gómez, MD Eréndira Chávez-González, MD Miguel Martínez-Rodríguez, MD Antonio Helue-Mena, MD Alma Gámez-Varela, MD Rogelio Cruz-Martinez, MD, PhD |
| author_facet | Hugo López-Briones, MD Rosa Villalobos-Gómez, MD Eréndira Chávez-González, MD Miguel Martínez-Rodríguez, MD Antonio Helue-Mena, MD Alma Gámez-Varela, MD Rogelio Cruz-Martinez, MD, PhD |
| author_sort | Hugo López-Briones, MD |
| collection | DOAJ |
| description | BACKGROUND: Because of the progressive nature of twin-to-twin transfusion syndrome, difficulties in healthcare access during the COVID-19 pandemic may lead to delayed diagnosis and referral to fetal surgery centers, which may have repercussions on outcomes. OBJECTIVE: This study aimed to assess the clinical impact of the COVID-19 pandemic on pregnancies complicated with twin-to-twin transfusion syndrome. STUDY DESIGN: A retrospective cohort study of consecutive monochorionic diamniotic twin pregnancies complicated with twin-to-twin transfusion syndrome evaluated in our national referral fetal surgery center at Queretaro, Mexico, for possible surgical fetoscopy was conducted. Maternal-fetal characteristics and perinatal outcomes of cases evaluated during the first year of the World Health Organization's COVID-19 pandemic declaration (March 11, 2020 to March 10, 2021) were retrospectively compared with outcomes of cases evaluated during the same period in the previous year (March 11, 2019 to March 10, 2020). RESULTS: Overall, 109 consecutive twin-to-twin transfusion syndrome cases were evaluated during the 2-year study period, 54 during the COVID-19 pandemic and 55 in the previous year. In the former group, a higher proportion of cases with fetal surveillance interval longer than 2 weeks (70.4% vs 47.3%; P=.01); twin-to-twin transfusion syndrome complications precluding laser therapy, such as intrauterine fetal demise, preterm rupture of membranes, or cervical dilatation with prolapsed amniotic membranes (18.5% vs 1.8%; P<.01); advanced twin-to-twin transfusion syndrome (53.7% vs 36.4%; P=.07); preoperative short cervix (25.9% vs 10.9%; P<.05); and lower overall perinatal survival (56.9% vs 80.0% [P=.01; at least 1 twin] and 39.2% vs 56.4% [P=.08; both twins], respectively) were observed. A significantly lower number of cases were selected for fetoscopic laser therapy during the pandemic (75.9% vs 92.7%; P=.01), with similar postoperative outcomes seen in both study periods. CONCLUSION: In pregnancies with twin-to-twin transfusion syndrome, the COVID-19 pandemic has shown an adverse impact involving suboptimal fetal surveillance, advanced stages at diagnosis, poorer survival rates, and higher number of complications that preclude fetoscopic laser therapy. |
| first_indexed | 2024-12-20T18:53:57Z |
| format | Article |
| id | doaj.art-ff509551a5a244629e3ad05df224ad3b |
| institution | Directory Open Access Journal |
| issn | 2666-5778 |
| language | English |
| last_indexed | 2024-12-20T18:53:57Z |
| publishDate | 2022-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | AJOG Global Reports |
| spelling | doaj.art-ff509551a5a244629e3ad05df224ad3b2022-12-21T19:29:34ZengElsevierAJOG Global Reports2666-57782022-02-0121100040Twin-to-twin transfusion syndrome and coronavirus disease 2019: impact on diagnosis, referral, eligibility for fetoscopic laser therapy, and outcomesAJOG Global Reports at a GlanceHugo López-Briones, MD0Rosa Villalobos-Gómez, MD1Eréndira Chávez-González, MD2Miguel Martínez-Rodríguez, MD3Antonio Helue-Mena, MD4Alma Gámez-Varela, MD5Rogelio Cruz-Martinez, MD, PhD6Fetal Medicine and Surgery Center, Medicina Fetal México, and Fetal Medicine Mexico Foundation, Queretaro, Mexico (Drs López-Briones, Rosa Villalobos-Gómez, Chávez-González, Martínez-Rodríguez, Helue-Mena, Gámez-Varela, and Cruz-Martinez)Fetal Medicine and Surgery Center, Medicina Fetal México, and Fetal Medicine Mexico Foundation, Queretaro, Mexico (Drs López-Briones, Rosa Villalobos-Gómez, Chávez-González, Martínez-Rodríguez, Helue-Mena, Gámez-Varela, and Cruz-Martinez)Fetal Medicine and Surgery Center, Medicina Fetal México, and Fetal Medicine Mexico Foundation, Queretaro, Mexico (Drs López-Briones, Rosa Villalobos-Gómez, Chávez-González, Martínez-Rodríguez, Helue-Mena, Gámez-Varela, and Cruz-Martinez)Fetal Medicine and Surgery Center, Medicina Fetal México, and Fetal Medicine Mexico Foundation, Queretaro, Mexico (Drs López-Briones, Rosa Villalobos-Gómez, Chávez-González, Martínez-Rodríguez, Helue-Mena, Gámez-Varela, and Cruz-Martinez)Fetal Medicine and Surgery Center, Medicina Fetal México, and Fetal Medicine Mexico Foundation, Queretaro, Mexico (Drs López-Briones, Rosa Villalobos-Gómez, Chávez-González, Martínez-Rodríguez, Helue-Mena, Gámez-Varela, and Cruz-Martinez)Fetal Medicine and Surgery Center, Medicina Fetal México, and Fetal Medicine Mexico Foundation, Queretaro, Mexico (Drs López-Briones, Rosa Villalobos-Gómez, Chávez-González, Martínez-Rodríguez, Helue-Mena, Gámez-Varela, and Cruz-Martinez)Fetal Medicine and Surgery Center, Medicina Fetal México, and Fetal Medicine Mexico Foundation, Queretaro, Mexico (Drs López-Briones, Rosa Villalobos-Gómez, Chávez-González, Martínez-Rodríguez, Helue-Mena, Gámez-Varela, and Cruz-Martinez); Instituto de Ciencias de Salud, Universidad Autónoma del Estado de Hidalgo, Hidalgo, México (Dr Cruz-Martinez); Corresponding author: Rogelio Cruz-Martinez, MD, PhDBACKGROUND: Because of the progressive nature of twin-to-twin transfusion syndrome, difficulties in healthcare access during the COVID-19 pandemic may lead to delayed diagnosis and referral to fetal surgery centers, which may have repercussions on outcomes. OBJECTIVE: This study aimed to assess the clinical impact of the COVID-19 pandemic on pregnancies complicated with twin-to-twin transfusion syndrome. STUDY DESIGN: A retrospective cohort study of consecutive monochorionic diamniotic twin pregnancies complicated with twin-to-twin transfusion syndrome evaluated in our national referral fetal surgery center at Queretaro, Mexico, for possible surgical fetoscopy was conducted. Maternal-fetal characteristics and perinatal outcomes of cases evaluated during the first year of the World Health Organization's COVID-19 pandemic declaration (March 11, 2020 to March 10, 2021) were retrospectively compared with outcomes of cases evaluated during the same period in the previous year (March 11, 2019 to March 10, 2020). RESULTS: Overall, 109 consecutive twin-to-twin transfusion syndrome cases were evaluated during the 2-year study period, 54 during the COVID-19 pandemic and 55 in the previous year. In the former group, a higher proportion of cases with fetal surveillance interval longer than 2 weeks (70.4% vs 47.3%; P=.01); twin-to-twin transfusion syndrome complications precluding laser therapy, such as intrauterine fetal demise, preterm rupture of membranes, or cervical dilatation with prolapsed amniotic membranes (18.5% vs 1.8%; P<.01); advanced twin-to-twin transfusion syndrome (53.7% vs 36.4%; P=.07); preoperative short cervix (25.9% vs 10.9%; P<.05); and lower overall perinatal survival (56.9% vs 80.0% [P=.01; at least 1 twin] and 39.2% vs 56.4% [P=.08; both twins], respectively) were observed. A significantly lower number of cases were selected for fetoscopic laser therapy during the pandemic (75.9% vs 92.7%; P=.01), with similar postoperative outcomes seen in both study periods. CONCLUSION: In pregnancies with twin-to-twin transfusion syndrome, the COVID-19 pandemic has shown an adverse impact involving suboptimal fetal surveillance, advanced stages at diagnosis, poorer survival rates, and higher number of complications that preclude fetoscopic laser therapy.http://www.sciencedirect.com/science/article/pii/S2666577821000381coronavirusCOVID-19fetal surgeryfetoscopypandemicplacental laser |
| spellingShingle | Hugo López-Briones, MD Rosa Villalobos-Gómez, MD Eréndira Chávez-González, MD Miguel Martínez-Rodríguez, MD Antonio Helue-Mena, MD Alma Gámez-Varela, MD Rogelio Cruz-Martinez, MD, PhD Twin-to-twin transfusion syndrome and coronavirus disease 2019: impact on diagnosis, referral, eligibility for fetoscopic laser therapy, and outcomesAJOG Global Reports at a Glance AJOG Global Reports coronavirus COVID-19 fetal surgery fetoscopy pandemic placental laser |
| title | Twin-to-twin transfusion syndrome and coronavirus disease 2019: impact on diagnosis, referral, eligibility for fetoscopic laser therapy, and outcomesAJOG Global Reports at a Glance |
| title_full | Twin-to-twin transfusion syndrome and coronavirus disease 2019: impact on diagnosis, referral, eligibility for fetoscopic laser therapy, and outcomesAJOG Global Reports at a Glance |
| title_fullStr | Twin-to-twin transfusion syndrome and coronavirus disease 2019: impact on diagnosis, referral, eligibility for fetoscopic laser therapy, and outcomesAJOG Global Reports at a Glance |
| title_full_unstemmed | Twin-to-twin transfusion syndrome and coronavirus disease 2019: impact on diagnosis, referral, eligibility for fetoscopic laser therapy, and outcomesAJOG Global Reports at a Glance |
| title_short | Twin-to-twin transfusion syndrome and coronavirus disease 2019: impact on diagnosis, referral, eligibility for fetoscopic laser therapy, and outcomesAJOG Global Reports at a Glance |
| title_sort | twin to twin transfusion syndrome and coronavirus disease 2019 impact on diagnosis referral eligibility for fetoscopic laser therapy and outcomesajog global reports at a glance |
| topic | coronavirus COVID-19 fetal surgery fetoscopy pandemic placental laser |
| url | http://www.sciencedirect.com/science/article/pii/S2666577821000381 |
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