Journal
ULTRASOUND IN OBSTETRICS & GYNECOLOGY
Volume 37, Issue 4, Pages 458-462Publisher
WILEY-BLACKWELL
DOI: 10.1002/uog.8922
Keywords
amniotic band syndrome; fetal therapy; septostomy; TTTS; twin-twin transfusion syndrome
Funding
- Fondo de Investigacion Sanitaria (FIS) of the Ministerio de Sanidad y Consumo [PI 06/0585]
- EuroSTEC [LSHB-CT-2006-037409]
- Carlos III Institute of Health (Spain) [CM08/00105]
- Mexican National Council for Science and Technology (CONACyT), in Mexico City
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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 (C) 2011 ISUOG. Published by John Wiley & Sons, Ltd.
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