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Model Surgical Training: Skills Acquisition in Fetoscopic Laser Photocoagulation of Monochorionic Diamniotic Twin Placenta Using Realistic Simulators
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Chorioamniotic Membrane Separation after Fetoscopic Laser Photocoagulation.

Mayumi Takano1, Masahiko Nakata, Susumu Murata

  • 1Department of Obstetrics and Gynecology, Toho University Graduate School of Medicine, Tokyo, Japan.

Fetal Diagnosis and Therapy
|April 24, 2017
PubMed
Summary

Chorioamniotic membrane separation (CMS) after fetoscopic laser photocoagulation (FLP) for twin-to-twin transfusion syndrome (TTTS) occurred in 13% of cases. Surgery before 20 weeks gestation was the only risk factor. CMS increased preterm PROM risk but not delivery or survival rates.

Keywords:
Chorioamniotic membrane separationFetoscopic laser photocoagulationPremature rupture of membranesSelective intrauterine growth restrictionTwin-to-twin transfusion syndrome

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Area of Science:

  • Maternal-Fetal Medicine
  • Reproductive Surgery
  • Neonatal Outcomes

Background:

  • Twin-to-twin transfusion syndrome (TTTS) is a serious complication of monochorionic twins.
  • Fetoscopic laser photocoagulation (FLP) is a common treatment for TTTS.
  • Chorioamniotic membrane separation (CMS) is a potential complication following FLP.

Purpose of the Study:

  • To investigate the incidence and risk factors of CMS after FLP for TTTS.
  • To evaluate the influence of CMS on perinatal outcomes.

Main Methods:

  • Retrospective study of 312 women undergoing FLP for TTTS.
  • Analysis of clinical records, obstetrical examinations, complications, operative data, and ultrasonographic findings.
  • Review of perinatal and neonatal follow-up data.

Main Results:

  • The incidence of CMS was 12.7% (33/260 cases).
  • Performing FLP before 20 weeks of gestational age was the sole independent risk factor for CMS (OR=3.38).
  • CMS was associated with an increased risk of premature rupture of membranes (PROM) before 32 weeks (33.3% vs 13.9%), but not with differences in gestational age at delivery or survival rates.

Conclusions:

  • The incidence of CMS post-FLP for TTTS is approximately 13%.
  • Early FLP (<20 weeks GA) is the primary risk factor for CMS.
  • While CMS did not negatively impact preterm delivery or survival, the elevated preterm PROM risk necessitates careful patient management.