Twin‐to‐twin transfusion syndrome after 26 weeks of gestation: is there a role for fetoscopic laser surgery?
Objective To compare fetoscopic laser surgery with amniodrainage in the treatment of twin‐to‐twin transfusion syndrome (TTTS) diagnosed after 26 weeks of gestation. Design A retrospective cohort study. Setting Leiden University Medical Centre, a tertiary referral hospital for fetal therapy. Popul...
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| Veröffentlicht in: | BJOG : an international journal of obstetrics and gynaecology 2007-06, Vol.114 (6), p.694-698 |
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| container_title | BJOG : an international journal of obstetrics and gynaecology |
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| creator | Middeldorp, JM Lopriore, E Sueters, M Klumper, FJCM Kanhai, HHH Vandenbussche, FPHA Oepkes, D |
| description | Objective To compare fetoscopic laser surgery with amniodrainage in the treatment of twin‐to‐twin transfusion syndrome (TTTS) diagnosed after 26 weeks of gestation.
Design A retrospective cohort study.
Setting Leiden University Medical Centre, a tertiary referral hospital for fetal therapy.
Population Between January 1991 and February 2006, 21 TTTS cases were diagnosed and treated after 26 weeks of gestation.
Methods Treatment of TTTS consisted of either amniodrainage or fetoscopic laser coagulation of vascular anastomoses.
Main outcome measures Primary outcome: adverse outcome (intrauterine or neonatal death, major neonatal morbidity and/or severe cerebral injury). Secondary outcome: gestational age at birth.
Results Eleven TTTS cases were treated with amniodrainage and ten with laser surgery. Median gestational age at birth in the amniodrainage group and in the laser surgery group was 29 and 31 weeks, respectively (P = 0.17) All infants were born alive. Major neonatal morbidity occurred more often in the amniodrainage group than in the laser surgery group, 27% (6/22) and 0% (0/20), respectively (P = 0.02). Severe cerebral injury in the amniodrainage group and in the laser surgery group occurred in 23% (5/22) and 15% (3/20) of infants, respectively (P = 0.70). Neonatal mortality in the amniodrainage group and in the laser surgery group was 14% (3/22) and 0% (0/20), respectively (P = 0.23). Overall adverse outcome was 36% (8/22) in the amniodrainage group and 15% (3/20) in the laser surgery group (P = 0.17).
Conclusion In TTTS diagnosed after 26 weeks of gestation, amniodrainage and laser surgery both result in 100% survival. However, infants born after laser surgery have less major neonatal morbidity. |
| doi_str_mv | 10.1111/j.1471-0528.2007.01337.x |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_70506850</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1274468941</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4247-e683de4c88b12265d5daf5edeaf4aaa13bfd2df94c39929c955e3ec7888473dd3</originalsourceid><addsrcrecordid>eNqNkc2KFDEUhYMozjj6ChIE3VWZn0olJYjo4C8DsxnXIZ3cjNVWV9rcKnp65yP4jD6JqenGAVdmkVzIdy6HcwihnNW8nJfrmjeaV0wJUwvGdM24lLq-uUdO_37cv51ZxaQwJ-QR4pox3gomH5ITrhVvu5adku3Vrh9___w1peUqM52yGzHO2KeR4n4MOW2AujhBpqKlO4DvSFOk14CTmwr0ivZIp2-QC0VzGoDGlGmEKaFP297TwWHR4pyvIe_fPCYPohsQnhzfM_L1w_ur80_VxeXHz-dvLyrfiEZX0BoZoPHGrLgQrQoquKgggIuNc47LVQwixK7xsutE5zulQILXxphGyxDkGXlx2LvN6cdczNpNjx6GwY2QZrSaKdYaxQr47B9wneY8Fm9WCNWyzjQLZA6QzwkxQ7Tb3G9c3lvO7FKJXdslebskb5dK7G0l9qZInx73z6sNhDvhsYMCPD8CDr0bYsnf93jHGa1FgQv3-sDt-gH2_23AvvtyuUzyD_zPqgs</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>225609840</pqid></control><display><type>article</type><title>Twin‐to‐twin transfusion syndrome after 26 weeks of gestation: is there a role for fetoscopic laser surgery?</title><source>MEDLINE</source><source>Wiley Online Library All Journals</source><creator>Middeldorp, JM ; Lopriore, E ; Sueters, M ; Klumper, FJCM ; Kanhai, HHH ; Vandenbussche, FPHA ; Oepkes, D</creator><creatorcontrib>Middeldorp, JM ; Lopriore, E ; Sueters, M ; Klumper, FJCM ; Kanhai, HHH ; Vandenbussche, FPHA ; Oepkes, D</creatorcontrib><description>Objective To compare fetoscopic laser surgery with amniodrainage in the treatment of twin‐to‐twin transfusion syndrome (TTTS) diagnosed after 26 weeks of gestation.
Design A retrospective cohort study.
Setting Leiden University Medical Centre, a tertiary referral hospital for fetal therapy.
Population Between January 1991 and February 2006, 21 TTTS cases were diagnosed and treated after 26 weeks of gestation.
Methods Treatment of TTTS consisted of either amniodrainage or fetoscopic laser coagulation of vascular anastomoses.
Main outcome measures Primary outcome: adverse outcome (intrauterine or neonatal death, major neonatal morbidity and/or severe cerebral injury). Secondary outcome: gestational age at birth.
Results Eleven TTTS cases were treated with amniodrainage and ten with laser surgery. Median gestational age at birth in the amniodrainage group and in the laser surgery group was 29 and 31 weeks, respectively (P = 0.17) All infants were born alive. Major neonatal morbidity occurred more often in the amniodrainage group than in the laser surgery group, 27% (6/22) and 0% (0/20), respectively (P = 0.02). Severe cerebral injury in the amniodrainage group and in the laser surgery group occurred in 23% (5/22) and 15% (3/20) of infants, respectively (P = 0.70). Neonatal mortality in the amniodrainage group and in the laser surgery group was 14% (3/22) and 0% (0/20), respectively (P = 0.23). Overall adverse outcome was 36% (8/22) in the amniodrainage group and 15% (3/20) in the laser surgery group (P = 0.17).
Conclusion In TTTS diagnosed after 26 weeks of gestation, amniodrainage and laser surgery both result in 100% survival. However, infants born after laser surgery have less major neonatal morbidity.</description><identifier>ISSN: 1470-0328</identifier><identifier>EISSN: 1471-0528</identifier><identifier>DOI: 10.1111/j.1471-0528.2007.01337.x</identifier><identifier>PMID: 17516960</identifier><identifier>CODEN: BIOGFQ</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Adult ; Amniodrainage ; Amnion - surgery ; Biological and medical sciences ; Cohort Studies ; Comparative studies ; Drainage - methods ; Female ; Fetofetal Transfusion - surgery ; fetoscopic laser coagulation of vascular anastomoses ; Fetoscopy - methods ; Fetuses ; Gestational Age ; Gynecology. Andrology. Obstetrics ; Humans ; Infant ; Laser Coagulation - methods ; Lasers ; Medical disorders ; Medical procedures ; Medical sciences ; neonatal morbidity ; Obstetrics ; perinatal mortality ; Pregnancy ; Pregnancy Outcome ; Pregnancy Trimester, Second ; Retrospective Studies ; Surgical techniques ; Twins ; twin‐to‐twin transfusion syndrome</subject><ispartof>BJOG : an international journal of obstetrics and gynaecology, 2007-06, Vol.114 (6), p.694-698</ispartof><rights>RCOG 2007 BJOG An International Journal of Obstetrics and Gynaecology</rights><rights>2007 INIST-CNRS</rights><rights>2007 The Authors Journal compilation</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4247-e683de4c88b12265d5daf5edeaf4aaa13bfd2df94c39929c955e3ec7888473dd3</citedby><cites>FETCH-LOGICAL-c4247-e683de4c88b12265d5daf5edeaf4aaa13bfd2df94c39929c955e3ec7888473dd3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1471-0528.2007.01337.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1471-0528.2007.01337.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=18772175$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17516960$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Middeldorp, JM</creatorcontrib><creatorcontrib>Lopriore, E</creatorcontrib><creatorcontrib>Sueters, M</creatorcontrib><creatorcontrib>Klumper, FJCM</creatorcontrib><creatorcontrib>Kanhai, HHH</creatorcontrib><creatorcontrib>Vandenbussche, FPHA</creatorcontrib><creatorcontrib>Oepkes, D</creatorcontrib><title>Twin‐to‐twin transfusion syndrome after 26 weeks of gestation: is there a role for fetoscopic laser surgery?</title><title>BJOG : an international journal of obstetrics and gynaecology</title><addtitle>BJOG</addtitle><description>Objective To compare fetoscopic laser surgery with amniodrainage in the treatment of twin‐to‐twin transfusion syndrome (TTTS) diagnosed after 26 weeks of gestation.
Design A retrospective cohort study.
Setting Leiden University Medical Centre, a tertiary referral hospital for fetal therapy.
Population Between January 1991 and February 2006, 21 TTTS cases were diagnosed and treated after 26 weeks of gestation.
Methods Treatment of TTTS consisted of either amniodrainage or fetoscopic laser coagulation of vascular anastomoses.
Main outcome measures Primary outcome: adverse outcome (intrauterine or neonatal death, major neonatal morbidity and/or severe cerebral injury). Secondary outcome: gestational age at birth.
Results Eleven TTTS cases were treated with amniodrainage and ten with laser surgery. Median gestational age at birth in the amniodrainage group and in the laser surgery group was 29 and 31 weeks, respectively (P = 0.17) All infants were born alive. Major neonatal morbidity occurred more often in the amniodrainage group than in the laser surgery group, 27% (6/22) and 0% (0/20), respectively (P = 0.02). Severe cerebral injury in the amniodrainage group and in the laser surgery group occurred in 23% (5/22) and 15% (3/20) of infants, respectively (P = 0.70). Neonatal mortality in the amniodrainage group and in the laser surgery group was 14% (3/22) and 0% (0/20), respectively (P = 0.23). Overall adverse outcome was 36% (8/22) in the amniodrainage group and 15% (3/20) in the laser surgery group (P = 0.17).
Conclusion In TTTS diagnosed after 26 weeks of gestation, amniodrainage and laser surgery both result in 100% survival. However, infants born after laser surgery have less major neonatal morbidity.</description><subject>Adult</subject><subject>Amniodrainage</subject><subject>Amnion - surgery</subject><subject>Biological and medical sciences</subject><subject>Cohort Studies</subject><subject>Comparative studies</subject><subject>Drainage - methods</subject><subject>Female</subject><subject>Fetofetal Transfusion - surgery</subject><subject>fetoscopic laser coagulation of vascular anastomoses</subject><subject>Fetoscopy - methods</subject><subject>Fetuses</subject><subject>Gestational Age</subject><subject>Gynecology. Andrology. Obstetrics</subject><subject>Humans</subject><subject>Infant</subject><subject>Laser Coagulation - methods</subject><subject>Lasers</subject><subject>Medical disorders</subject><subject>Medical procedures</subject><subject>Medical sciences</subject><subject>neonatal morbidity</subject><subject>Obstetrics</subject><subject>perinatal mortality</subject><subject>Pregnancy</subject><subject>Pregnancy Outcome</subject><subject>Pregnancy Trimester, Second</subject><subject>Retrospective Studies</subject><subject>Surgical techniques</subject><subject>Twins</subject><subject>twin‐to‐twin transfusion syndrome</subject><issn>1470-0328</issn><issn>1471-0528</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkc2KFDEUhYMozjj6ChIE3VWZn0olJYjo4C8DsxnXIZ3cjNVWV9rcKnp65yP4jD6JqenGAVdmkVzIdy6HcwihnNW8nJfrmjeaV0wJUwvGdM24lLq-uUdO_37cv51ZxaQwJ-QR4pox3gomH5ITrhVvu5adku3Vrh9___w1peUqM52yGzHO2KeR4n4MOW2AujhBpqKlO4DvSFOk14CTmwr0ivZIp2-QC0VzGoDGlGmEKaFP297TwWHR4pyvIe_fPCYPohsQnhzfM_L1w_ur80_VxeXHz-dvLyrfiEZX0BoZoPHGrLgQrQoquKgggIuNc47LVQwixK7xsutE5zulQILXxphGyxDkGXlx2LvN6cdczNpNjx6GwY2QZrSaKdYaxQr47B9wneY8Fm9WCNWyzjQLZA6QzwkxQ7Tb3G9c3lvO7FKJXdslebskb5dK7G0l9qZInx73z6sNhDvhsYMCPD8CDr0bYsnf93jHGa1FgQv3-sDt-gH2_23AvvtyuUzyD_zPqgs</recordid><startdate>200706</startdate><enddate>200706</enddate><creator>Middeldorp, JM</creator><creator>Lopriore, E</creator><creator>Sueters, M</creator><creator>Klumper, FJCM</creator><creator>Kanhai, HHH</creator><creator>Vandenbussche, FPHA</creator><creator>Oepkes, D</creator><general>Blackwell Publishing Ltd</general><general>Blackwell</general><general>Wiley Subscription Services, Inc</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>ASE</scope><scope>FPQ</scope><scope>K6X</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>200706</creationdate><title>Twin‐to‐twin transfusion syndrome after 26 weeks of gestation: is there a role for fetoscopic laser surgery?</title><author>Middeldorp, JM ; Lopriore, E ; Sueters, M ; Klumper, FJCM ; Kanhai, HHH ; Vandenbussche, FPHA ; Oepkes, D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4247-e683de4c88b12265d5daf5edeaf4aaa13bfd2df94c39929c955e3ec7888473dd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Adult</topic><topic>Amniodrainage</topic><topic>Amnion - surgery</topic><topic>Biological and medical sciences</topic><topic>Cohort Studies</topic><topic>Comparative studies</topic><topic>Drainage - methods</topic><topic>Female</topic><topic>Fetofetal Transfusion - surgery</topic><topic>fetoscopic laser coagulation of vascular anastomoses</topic><topic>Fetoscopy - methods</topic><topic>Fetuses</topic><topic>Gestational Age</topic><topic>Gynecology. Andrology. Obstetrics</topic><topic>Humans</topic><topic>Infant</topic><topic>Laser Coagulation - methods</topic><topic>Lasers</topic><topic>Medical disorders</topic><topic>Medical procedures</topic><topic>Medical sciences</topic><topic>neonatal morbidity</topic><topic>Obstetrics</topic><topic>perinatal mortality</topic><topic>Pregnancy</topic><topic>Pregnancy Outcome</topic><topic>Pregnancy Trimester, Second</topic><topic>Retrospective Studies</topic><topic>Surgical techniques</topic><topic>Twins</topic><topic>twin‐to‐twin transfusion syndrome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Middeldorp, JM</creatorcontrib><creatorcontrib>Lopriore, E</creatorcontrib><creatorcontrib>Sueters, M</creatorcontrib><creatorcontrib>Klumper, FJCM</creatorcontrib><creatorcontrib>Kanhai, HHH</creatorcontrib><creatorcontrib>Vandenbussche, FPHA</creatorcontrib><creatorcontrib>Oepkes, D</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>British Nursing Index</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>BJOG : an international journal of obstetrics and gynaecology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Middeldorp, JM</au><au>Lopriore, E</au><au>Sueters, M</au><au>Klumper, FJCM</au><au>Kanhai, HHH</au><au>Vandenbussche, FPHA</au><au>Oepkes, D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Twin‐to‐twin transfusion syndrome after 26 weeks of gestation: is there a role for fetoscopic laser surgery?</atitle><jtitle>BJOG : an international journal of obstetrics and gynaecology</jtitle><addtitle>BJOG</addtitle><date>2007-06</date><risdate>2007</risdate><volume>114</volume><issue>6</issue><spage>694</spage><epage>698</epage><pages>694-698</pages><issn>1470-0328</issn><eissn>1471-0528</eissn><coden>BIOGFQ</coden><abstract>Objective To compare fetoscopic laser surgery with amniodrainage in the treatment of twin‐to‐twin transfusion syndrome (TTTS) diagnosed after 26 weeks of gestation.
Design A retrospective cohort study.
Setting Leiden University Medical Centre, a tertiary referral hospital for fetal therapy.
Population Between January 1991 and February 2006, 21 TTTS cases were diagnosed and treated after 26 weeks of gestation.
Methods Treatment of TTTS consisted of either amniodrainage or fetoscopic laser coagulation of vascular anastomoses.
Main outcome measures Primary outcome: adverse outcome (intrauterine or neonatal death, major neonatal morbidity and/or severe cerebral injury). Secondary outcome: gestational age at birth.
Results Eleven TTTS cases were treated with amniodrainage and ten with laser surgery. Median gestational age at birth in the amniodrainage group and in the laser surgery group was 29 and 31 weeks, respectively (P = 0.17) All infants were born alive. Major neonatal morbidity occurred more often in the amniodrainage group than in the laser surgery group, 27% (6/22) and 0% (0/20), respectively (P = 0.02). Severe cerebral injury in the amniodrainage group and in the laser surgery group occurred in 23% (5/22) and 15% (3/20) of infants, respectively (P = 0.70). Neonatal mortality in the amniodrainage group and in the laser surgery group was 14% (3/22) and 0% (0/20), respectively (P = 0.23). Overall adverse outcome was 36% (8/22) in the amniodrainage group and 15% (3/20) in the laser surgery group (P = 0.17).
Conclusion In TTTS diagnosed after 26 weeks of gestation, amniodrainage and laser surgery both result in 100% survival. However, infants born after laser surgery have less major neonatal morbidity.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>17516960</pmid><doi>10.1111/j.1471-0528.2007.01337.x</doi><tpages>5</tpages></addata></record> |
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| subjects | Adult Amniodrainage Amnion - surgery Biological and medical sciences Cohort Studies Comparative studies Drainage - methods Female Fetofetal Transfusion - surgery fetoscopic laser coagulation of vascular anastomoses Fetoscopy - methods Fetuses Gestational Age Gynecology. Andrology. Obstetrics Humans Infant Laser Coagulation - methods Lasers Medical disorders Medical procedures Medical sciences neonatal morbidity Obstetrics perinatal mortality Pregnancy Pregnancy Outcome Pregnancy Trimester, Second Retrospective Studies Surgical techniques Twins twin‐to‐twin transfusion syndrome |
| title | Twin‐to‐twin transfusion syndrome after 26 weeks of gestation: is there a role for fetoscopic laser surgery? |
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