Volume 11, Issue 4 (2023)
Health Educ Health Promot 2023, 11(4): 675-679 |
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Dehghani Z, Rasekhi A, Marsoosi V, Mohammadi S. Comparison of Twin-to-Twin Transfusion Syndrome and Without Selective Fetal Growth Restriction Before Fetoscopic Laser Photocoagulation in Iran. Health Educ Health Promot 2023; 11 (4) :675-679
URL: http://hehp.modares.ac.ir/article-5-72083-en.html
URL: http://hehp.modares.ac.ir/article-5-72083-en.html
1- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
2- Department of Obstetrics and Gynecology, Dr. Ali Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
3- Department of Obstetrics and Gynecology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2- Department of Obstetrics and Gynecology, Dr. Ali Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
3- Department of Obstetrics and Gynecology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Abstract: (303 Views)
Aims: This study compared two groups of twin pregnancies complicated by twin-to-twin transfusion syndrome (TTTS), with and without selective fetal growth restriction (sFGR), and evaluated the survival rate at 30 days after birth treated with fetoscopic laser photocoagulation (FLP).
Materials & Methods: The present study was a retrospective study of 164 diamniotic monochorionic twin pregnancies complicated with TTTS and treated with FLP. The sFGR was defined as an estimated fetal weight below the 10th percentile. The independent t-test, Chi-square test, or Fisher's exact test were used for statistical analysis. Multiple logistic regression analysis was performed to identify 30-day donor twin survival risk factors for the entire study population. The significance level was determined at p<0.05.
Findings: Of the studied cases, 45.1% had only TTTS, while 54.9% had both TTTS and sFGR. .There was a significant difference (p<0.001) in the distribution of Quintero stages and maternal age during the intervention (p=0.01) between the two groups. The sFGR before laser surgery in TTTS patients was associated with reduced donor survival. The multivariate analysis revealed that gestational age at delivery (OR=0.81, 95%CI:0.7-0.8) and sFGR (OR=0.43, 95%CI:0.2-0.8) were significantly associated with donor survival.
Conclusion: The sFGR before FLP is present in approximately 55% of TTTS cases, which is caused by normal placental abnormalities. TTTS with sFGR is associated with reduced donor embryo survival. Gestational age at delivery and sFGR are important factors affecting donor survival 30 days after birth. Performing successive ultrasounds after diagnosing monochorionic twin pregnancies is essential for timely identification, correct management, and treatment.
Materials & Methods: The present study was a retrospective study of 164 diamniotic monochorionic twin pregnancies complicated with TTTS and treated with FLP. The sFGR was defined as an estimated fetal weight below the 10th percentile. The independent t-test, Chi-square test, or Fisher's exact test were used for statistical analysis. Multiple logistic regression analysis was performed to identify 30-day donor twin survival risk factors for the entire study population. The significance level was determined at p<0.05.
Findings: Of the studied cases, 45.1% had only TTTS, while 54.9% had both TTTS and sFGR. .There was a significant difference (p<0.001) in the distribution of Quintero stages and maternal age during the intervention (p=0.01) between the two groups. The sFGR before laser surgery in TTTS patients was associated with reduced donor survival. The multivariate analysis revealed that gestational age at delivery (OR=0.81, 95%CI:0.7-0.8) and sFGR (OR=0.43, 95%CI:0.2-0.8) were significantly associated with donor survival.
Conclusion: The sFGR before FLP is present in approximately 55% of TTTS cases, which is caused by normal placental abnormalities. TTTS with sFGR is associated with reduced donor embryo survival. Gestational age at delivery and sFGR are important factors affecting donor survival 30 days after birth. Performing successive ultrasounds after diagnosing monochorionic twin pregnancies is essential for timely identification, correct management, and treatment.
Article Type: Original Research |
Subject:
Family Health Education/Promotion
Received: 2023/10/22 | Accepted: 2023/11/18 | Published: 2023/11/30
Received: 2023/10/22 | Accepted: 2023/11/18 | Published: 2023/11/30
References
1. Long E, Ferriman E. Twin pregnancy. Obstet Gynaecol Reprod Med. 2016;26(2):38-45. [Link] [DOI:10.1016/j.ogrm.2015.11.010]
2. Ngamprasertwong P, Habli M, Boat A, Lim FY, Esslinger H, Ding L, et al. Maternal hypotension during fetoscopic surgery: Incidence and its impact on fetal survival outcomes. Scientific World J. 2013;2013:709059. [Link] [DOI:10.1155/2013/709059]
3. Bamberg C, Hecher K. Twin-to-twin transfusion syndrome: Controversies in the diagnosis and management. Best Pract Res Clin Obstet Gynaecol. 2022;84:143-54. [Link] [DOI:10.1016/j.bpobgyn.2022.03.013]
4. Cavicchioni O, Yamamoto M, Robyr R, Takahashi YV, Ville Y. Fetal medicine: Intrauterine fetal demise following laser treatment in twin‐to‐twin transfusion syndrome. Int J Obstet Gynaecol. 2006;113(5):590-4. [Link] [DOI:10.1111/j.1471-0528.2006.00913.x]
5. Benoit RM, Baschat AA. Twin-to-twin transfusion syndrome: prenatal diagnosis and treatment. Am J Perinatol. 2014;31(7):583-94. [Link] [DOI:10.1055/s-0034-1372428]
6. D'Antonio F, Thilaganathan B, Dias T, Khalil A, Collaborative STOR, Bahamie A, et al. Influence of chorionicity and gestational age at single fetal loss on risk of preterm birth in twin pregnancy: analysis of STORK multiple pregnancy cohort. Ultrasound Obstet Gynecol. 2017;50(6):723-7. [Link] [DOI:10.1002/uog.17426]
7. D'Antonio F, Herrera M, Oronzii L, Khalil A. Solomon technique vs selective fetoscopic laser photocoagulation for twin-twin transfusion syndrome: Systematic review and meta‐analysis of maternal and perinatal outcomes. Ultrasound Obstet Gynecol. 2022;60(6):731-8. [Link] [DOI:10.1002/uog.26095]
8. Bennasar M, Eixarch E, Martinez JM, Gratacós E, editors. Selective intrauterine growth restriction in monochorionic diamniotic twin pregnancies. Semin Fetal Neonatal Med. 2017;22(6):376-82. [Link] [DOI:10.1016/j.siny.2017.05.001]
9. Shinar S, Xing W, Pruthi V, Jianping C, Slaghekke F, Groene S, et al. Outcome of monochorionic twin pregnancy complicated by Type‐III selective intrauterine growth restriction. Ultrasound Obstet Gynecol. 2021;57(1):126-33. [Link] [DOI:10.1002/uog.23515]
10. Corsello G, Piro E. The world of twins: an update. J Matern Fetal Neonatal Med. 2010;23(sup3):59-62. [Link] [DOI:10.3109/14767058.2010.508218]
11. Sago H, Ishii K, Sugibayashi R, Ozawa K, Sumie M, Wada S. Fetoscopic laser photocoagulation for twin-twin transfusion syndrome. J Obstet Gynaecol Res. 2018;44(5):831-9. [Link] [DOI:10.1111/jog.13600]
12. Diehl W, Diemert A, Grasso D, Sehner S, Wegscheider K, Hecher K. Fetoscopic laser coagulation in 1020 pregnancies with twin-twin transfusion syndrome demonstrates improvement in double‐twin survival rate. Ultrasound Obstet Gynecol. 2017;50(6):728-35. [Link] [DOI:10.1002/uog.17520]
13. Baschat AA, Barber J, Pedersen N, Turan OM, Harman CR. Outcome after fetoscopic selective laser ablation of placental anastomoses vs equatorial laser dichorionization for the treatment of twin-to-twin transfusion syndrome. Am J Obstet Gynecol. 2013;209(3):234. [Link] [DOI:10.1016/j.ajog.2013.05.034]
14. Kajiwara K, Ozawa K, Wada S, Samura O. Molecular mechanisms underlying twin-to-twin transfusion syndrome. Cells. 2022;11(20):3268. [Link] [DOI:10.3390/cells11203268]
15. Van Winden KR, Quintero RA, Kontopoulos EV, Korst LM, Llanes A, Chmait RH. Perinatal survival in cases of twin-twin transfusion syndrome complicated by selective intrauterine growth restriction. J Matern Fetal Neonatal Med. 2015;28(13):1549-53. [Link] [DOI:10.3109/14767058.2014.960834]
16. Buca D, Pagani G, Rizzo G, Familiari A, Flacco ME, Manzoli L, et al. Outcome of monochorionic twin pregnancy with selective intrauterine growth restriction according to umbilical artery Doppler flow pattern of smaller twin: Systematic review and meta‐analysis. Ultrasound Obstet Gynecol. 2017;50(5):559-68. [Link] [DOI:10.1002/uog.17362]
17. Groene SG, Tollenaar LS, van Klink JM, Haak MC, Klumper FJ, Middeldorp JM, et al. Twin-twin transfusion syndrome with and without selective fetal growth restriction prior to fetoscopic laser surgery: Short and long-term outcome. J Clin Med. 2019;8(7):969. [Link] [DOI:10.3390/jcm8070969]
18. Van Winden K, Quintero R, Kontopoulos E, Korst L, Llanes A, Chmait R. 189: Perinatal survival in cases of twin-twin transfusion syndrome complicated by selective intrauterine growth restriction. Staging of twin-twin transfusion syndrome. J Matern Fetal Neonatal Med. 2015;28(13):1549-53. [Link] [DOI:10.3109/14767058.2014.960834]
19. Hamza A, Herr D, Solomayer E, Meyberg-Solomayer G. Polyhydramnios: causes, diagnosis and therapy. Geburtshilfe Frauenheilkd. 2013;73(12):1241-6. [Link] [DOI:10.1055/s-0033-1360163]
20. Quintero RA, Morales WJ, Allen MH, Bornick PW, Johnson PK, Kruger M. Staging of twin-twin transfusion syndrome. J Perinatol. 1999;19(8):550-5. [Link] [DOI:10.1038/sj.jp.7200292]
21. Carmant LS, Audibert F, Wavrant S, Thériault K, Codsi E. Impact of selective fetal growth restriction on laser therapy outcomes in twin-twin transfusion syndrome. Fetal Diagnosis Ther. 2023;50(1):47-53. [Link] [DOI:10.1159/000528774]
22. Townsend R, Khalil A. Fetal growth restriction in twins. Best Pract Res Clin Obstet Gynaecol. 2018;49:79-88. [Link] [DOI:10.1016/j.bpobgyn.2018.02.004]
23. Couck I, Ponnet S, Deprest J, Devlieger R, De Catte L, Lewi L. Outcome of monochorionic twin pregnancy with selective fetal growth restriction at 16, 20 or 30 weeks according to new Delphi consensus definition. Ultrasound Obstet Gynecol. 2020;56(6):821-30. [Link] [DOI:10.1002/uog.21975]
24. D'Antonio F, Marinceu D, Prasad S, Eltaweel N, Khalil A. Outcome following laser surgery of twin-twin transfusion syndrome complicated by selective fetal growth restriction: Systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2023;62(3):320-7. [Link] [DOI:10.1002/uog.26252]
25. Rahimi-Sharbaf F, Shirazi M, Golshahi F, Salari Z, Haghiri M, Ghaemi M, et al. Comparison of prenatal and neonatal outcomes of selective fetal growth restriction in monochorionic twin pregnancies with or without twin-to-twin transfusion syndrome after radiofrequency ablation. Iran J Med Sci. 2022;47(5):433-9. [Link]
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