Risk factors associated with preterm delivery after fetoscopic laser ablation for twin-twin transfusion syndrome

R. Papanna, D. Block-Abraham, L. K. Mann, I. A. Buhimschi, M. Bebbington, E. Garcia, N. Kahlek, C. Harman, A. Johnson, A. Baschat, K. J. Moise

Research output: Contribution to journalArticle

Abstract

Objective Despite improved perinatal survival following fetoscopic laser ablation (FLA) for twin-twin transfusion syndrome (TTTS), prematurity remains an important contributor to perinatal mortality and morbidity. The objective of the study was to identify risk factors for complicated preterm delivery after FLA. Methods Retrospective cohort study of prospectively collected data on maternal/fetal demographics and pre-operative, operative and postoperative variables of 459 patients treated with FLA in three USA fetal centers. Multivariate linear regression was performed to identify significant risk factors associated with preterm delivery, which were cross-validated using the k-fold method. Multivariate logistic regression was performed to identify risk factors for early compared with late preterm delivery based on median gestational age at delivery of 32 weeks. Results There were significant differences in case selection and outcomes between the centers. After controlling for the center of surgery, multivariate analysis indicated that a lower maternal age at procedure, a history of previous prematurity, shortened cervical length, use of amnioinfusion, a cannula diameter of 12 French (Fr), lack of a collagen plug placement and iatrogenic preterm premature rupture of membranes (iPPROM) were significantly associated with a lower gestational age at delivery. Conclusions Specific fetal/maternal and operative variables are associated with preterm delivery after FLA for the treatment of TTTS. Further studies to modify some of these variables may decrease the perinatal morbidity after laser therapy.

Original languageEnglish (US)
Pages (from-to)48-53
Number of pages6
JournalUltrasound in Obstetrics and Gynecology
Volume43
Issue number1
DOIs
StatePublished - Jan 1 2014

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Keywords

  • fetoscopy
  • laser photocoagulation
  • predictors
  • preterm delivery
  • twin-twin transfusion syndrome

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Reproductive Medicine
  • Radiology Nuclear Medicine and imaging
  • Obstetrics and Gynecology

Cite this

Papanna, R., Block-Abraham, D., Mann, L. K., Buhimschi, I. A., Bebbington, M., Garcia, E., Kahlek, N., Harman, C., Johnson, A., Baschat, A., & Moise, K. J. (2014). Risk factors associated with preterm delivery after fetoscopic laser ablation for twin-twin transfusion syndrome. Ultrasound in Obstetrics and Gynecology, 43(1), 48-53. https://doi.org/10.1002/uog.13206