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Incidence and clinical implications of early inadvertent septostomy after laser therapy for twin–twin transfusion syndrome
Author(s) -
CruzMartinez R.,
Van Mieghem T.,
Lewi L.,
Eixarch E.,
Cobo T.,
Martinez J. M.,
Deprest J.,
Gratacos E.
Publication year - 2011
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.8922
Subject(s) - medicine , incidence (geometry) , gestational age , twin to twin transfusion syndrome , obstetrics , surgery , premature rupture of membranes , rupture of membranes , pregnancy , gestation , physics , biology , optics , genetics
Objective To evaluate the incidence and clinical outcome of inadvertent septostomy after fetoscopic laser therapy for twin–twin transfusion syndrome (TTTS) and, particularly, to explore its association with the risk of developing pseudoamniotic band syndrome (PABS). Methods In a cohort of 414 consecutive monochorionic twin pregnancies with confirmed TTTS treated with laser, the incidence of postoperative septostomy within 1 week of the procedure was recorded prospectively. Rates of preterm delivery, preterm premature rupture of membranes (PPROM), intrauterine fetal demise (IUFD) and PABS were compared among cases with and without septostomy. Results The mean gestational age at laser therapy was 20.4 (range, 15.3–27.6) weeks. Postoperative septostomy occurred in 30 (7.2%) cases. Pregnancies complicated with septostomy had a significantly higher proportion of preterm delivery before 32 weeks (76.7% vs. 30.2%, P < 0.001), PPROM before 32 weeks (46.7% vs. 19.0%, P < 0.001), IUFD (43.3% vs. 25.8%, P < 0.05) and PABS (13.3% vs. 1.0%, P < 0.001), compared with pregnancies without septostomy. Conclusions Inadvertent septostomy occurred in 7% of cases after fetoscopic laser therapy and was associated with a substantially increased risk of adverse perinatal outcome and PABS. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.