Perinatal outcomes of twin pregnancies complicated by late twin-twin transfusion syndrome: A systematic review and meta-analysis.
amnioreduction
laser
meta-analysis
monochorionic
perinatal mortality
systematic review
twin-twin transfusion syndrome
twins
Journal
Acta obstetricia et gynecologica Scandinavica
ISSN: 1600-0412
Titre abrégé: Acta Obstet Gynecol Scand
Pays: United States
ID NLM: 0370343
Informations de publication
Date de publication:
05 2021
05 2021
Historique:
revised:
09
12
2020
received:
03
10
2020
accepted:
13
12
2020
pubmed:
19
12
2020
medline:
16
6
2021
entrez:
18
12
2020
Statut:
ppublish
Résumé
Untreated twin-to-twin transfusion syndrome (TTTS) is associated with a high risk of perinatal mortality and morbidity. Laser surgery is recommended before 26 weeks of gestation. However, the optimal management in case of late TTTS (occurring after 26 weeks of gestation) is yet to be established. We conducted a systematic review and meta-analysis to evaluate the outcomes of monochorionic-diamniotic twin pregnancies complicated by late TTTS according to different management options (expectant, laser therapy, amnioreduction, or delivery). The primary outcome was mortality, including single and double intrauterine, neonatal, and perinatal death. Secondary outcomes were composite morbidity, neuromorbidity, respiratory distress syndrome, admission to neonatal intensive care unit, intact survival (ie, free from neurological complications), and preterm birth before <32 weeks of gestation. Outcomes were reviewed according to the management and reported for the overall population of twins and disease status (ie, donor and recipient separately). Random-effect meta-analyses of proportions were used to analyze the data. Nine studies including 796 twin pregnancies affected by TTTS were included. No randomized controlled trials were available for inclusion. TTTS occurred at ≥26 weeks of gestation in 8.7% (95% CI 6.9%-10.9%; 67/769) of cases reporting TTTS at all gestations. Intrauterine death occurred in 17.7% (95% CI 4.9%-36.2%) of pregnancies managed expectantly, 5.3% (95% CI 0.9%-12.9%) of pregnancies treated with laser, and 0% (95% CI 0%-9%) after amnioreduction. Neonatal death occurred in 42.5% (95% CI 17.5%-69.7%) of pregnancies managed expectantly, in 2.8% (95% CI 0.3%-7.7%) of cases treated with laser, and in 20.2% (95% CI 6%-40%) after amnioreduction. Only one study (10 cases) reported data on immediate delivery after diagnosis with no perinatal deaths. Perinatal death incidence was 55.7% (95% CI 31.4%-78.6%) in twin pregnancies managed expectantly, 5.6% (95% CI 0.5%-15.3%) in those treated with laser, and 20.2% (95% CI 6%-40%) in those after amnioreduction. Intact survival was reported in 44.4%, 96.4%, and 78% of fetuses managed expectantly, with laser or amnioreduction, respectively. Evidence regarding perinatal mortality and morbidity in twin pregnancies complicated by late TTTS according to the different managements was of very low quality. Therefore further high-quality research in this field is needed to elucidate the optimal management of these pregnancies.
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
832-842Informations de copyright
© 2020 Nordic Federation of Societies of Obstetrics and Gynecology (NFOG). Published by John Wiley & Sons Ltd.
Références
Khalil A, Rodgers M, Baschat A, et al. ISUOG Practice Guidelines: role of ultrasound in twin pregnancy. Ultrasound Obstet Gynecol. 2016;47:247-263.
Lewi L, Deprest J, Hecher K. The vascular anastomoses in monochorionic twin pregnancies and their clinical consequences. Am J Obstet Gynecol. 2013;208:19-30.
Mosquera C, Miller RS, Simpson LL. Twin-twin transfusion syndrome. Semin Perinatol. 2012;36:182-189.
Roberts D, Neilson JP, Kilby MD, Gates S. Interventions for the treatment of twin-twin transfusion syndrome. Cochrane Database Syst Rev. 2014;1:CD002073.
Senat MV, Deprest J, Boulvain M, Paupe A, Winer N, Ville Y. Endoscopic laser surgery versus serial amnioreduction for severe twin-to-twin transfusion syndrome. N Engl J Med. 2004;351:136-144.
Diehl W, Diemert A, Grasso D, Sehner S, Wegscheider K, Hecher K. Fetoscopic laser coagulation in 1020 pregnancies with twin-twin transfusion syndrome demonstrates improvement in double-twin survival rate. Ultrasound Obstet Gynecol. 2017;50:728-735.
Van Klink J, Koopman H, Rijken M, Middeldorp J, Oepkes D, Lopriore E. Long-term neurodevelopmental outcome in survivors of twin-to-twin transfusion syndrome. Twin Res Hum Genet. 2016;19:255-261.
Di Mascio D, Khalil A, Rizzo G, et al. Risk of fetal loss following amniocentesis or chorionic villus sampling in twin pregnancy: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2020;56:647-655.
Gratacos E, Deprest J. Current experience with fetoscopy and the Eurofoetus registry for fetoscopic procedures. Eur J Obstet Gynecol Reprod Biol 2000; 92: 151-159.
Dickinson JE, Evans SF. The progression of disease stage in twin-twin transfusion syndrome. J Matern Fetal Neonatal Med. 2004;16:95-101.
Mari G, Roberts A, Detti L, et al. Perinatal morbidity and mortality rates in severe twin-twin transfusion syndrome: results of the International Amnioreduction Registry. Am J Obstet Gynecol. 2001;185:708-715.
Rossi AC, D’Addario V. Laser therapy and serial amnioreduction as treatment for twin-twin transfusion syndrome: a metaanalysis and review of literature. Am J Obstet Gynecol. 2008;198:147-152.
Rizzolo A, Shah PS, Boucorian I, et al. Cumulative effect of evidence-based practices on outcomes of preterm infants born at <29 weeks' gestational age. Am J Obstet Gynecol. 2020;222:181.e1-181.e10.
Middeldorp JM, Lopriore E, Sueters M, et al. Twin-to-twin transfusion syndrome after 26 weeks of gestation: is there a role for fetoscopic laser surgery? BJOG. 2007;114:694-698.
Valsky DV, Eixarch E, Martinez-Crespo JM, et al. Fetoscopic laser surgery for twin-to-twin transfusion syndrome after 26 weeks of gestation. Fetal Diagn Ther. 2012;31:30-34.
Baud D, Windrim R, Keunen J, et al. Fetoscopic laser therapy for twin-twin transfusion syndrome before 17 and after 26 weeks' gestation. Am J Obstet Gynecol. 2013;208:e1-7.
Prisma statement. http://www.prisma-statement.org/ [accessed 10 June 2020].
Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000;283:2008-2012.
Wells GA, Shea B, O’Connell D, et al.The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. [Accessed June 10, 2020].
Murad MH, Sultan S, Haffar S, Bazerbachi F. Methodological quality and synthesis of case series and case reports. BMJ Evid Based Med. 2018;23:60-63.
Guyatt GH, Oxman AD, Kunz R, et al. What is "quality of evidence" and why is it important to clinicians? BMJ. 2008;336:995-998.
Guyatt GH, Oxman AD, Vist GE, et al. GRADE Working Group. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336:924-926.
Higgins J, Thompson S, Deeks J, Altman D. Statistical heterogeneity in systematic reviews of clinical trials: a critical appraisal of guidelines and practice. J Health Serv Res Policy. 2002;7:51-61.
Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629-634.
Hunter JP, Saratzis A, Sutton AJ, Boucher RH, Sayers RD, Bown MJ. In meta-analyses of proportion studies, funnel plots were found to be an inaccurate method of assessing publication bias. J Clin Epidemiol. 2014;67:897-903.
Nakata M, Ishii K, Sumie M, et al. A prospective pilot study of fetoscopic laser surgery for twin-to-twin transfusion syndrome between 26 and 27 weeks of gestation. Taiwan J Obstet Gynecol. 2016;55:512-514.
Murata M, Ishii K, Taguchi T, et al. The prevalence and clinical features of twin-twin transfusion syndrome with onset during the third trimester. J Perinat Med. 2014;42:93-98.
Merhar SL, Kline-Fath BM, Meinzen-Derr J, Schibler KR, Leach JL. Fetal and postnatal brain MRI in premature infants with twin-twin transfusion syndrome. J Perinatol. 2013;33:112-118.
Has R, Akhan S, Topuz S, Ermiş H, Iyibozkurt C, Ibrahimoğlu L. Therapeutic amniocentesis for treatment of twin-twin transfusion syndrome. Arch Gynecol Obstet. 2005;271:22-25.
Gul A, Aslan H, Polat I, et al. Natural history of 11 cases of twin-twin transfusion syndrome without intervention. Twin Res. 2003;6:263-266.
Blaicher W, Ulm B, Ulm M, Kuhle S, Deutinger J, Bernaschek G. The twin-twin transfusion syndrome - an unsolved problem. Ultraschall Med. 2002;23:108-112.
Quintero RA, Dickinson JE, Morales WJ, et al. Stage-based treatment of twin-twin transfusion syndrome. Am J Obstet Gynecol. 2003;188:1333-1340.
Khalil A, Liu B. Controversies in the management of twin pregnancies. Ultrasound Obstet Gynecol. 2020 Aug 16. https://doi.org/10.1002/uog.22181. Epub ahead of print.
Ville Y, Hecher K, Gagnon A, Sebire N, Hyett J, Nicolaides K. Endoscopic laser coagulation in the management of severe twin-to-twin transfusion syndrome. Br J Obstet Gynaecol. 1998;105:446-453.
Hecher K, Diehl W, Zikulnig L, Vetter M, Hackelöer BJ. Endoscopic laser coagulation of placental anastomoses in 200 pregnancies with severe mid-trimester twin-to-twin transfusion syndrome. Eur J Obstet Gynecol Reprod Biol. 2000;92:135-139.
Rodeck CH, Weisz B, Peebles DM, Jauniaux E. Hypothesis: the placental ‘steal’ phenomenon - a possible hazard of amnioreduction. Fetal Diagn Ther. 2006;21:302-306.
Fichera A, Ambrosi C, Taddei F, Gasparotti R, Frusca T. Severe brain damage from twin-twin transfusion syndrome treated with serial amnioreductions after 26 weeks: a case to reconsider the gestational age limits of laser therapy. Fetal Diagn Ther. 2009;25:203-205.
Perry H, Duffy JMN, Umadia O, Khalil A. International Collaboration to Harmonise Outcomes for Twin-Twin Transfusion Syndrome (CHOOSE). Outcome reporting across randomized trials and observational studies evaluating treatments for twin-twin transfusion syndrome: systematic review. Ultrasound Obstet Gynecol. 2018;52:577-585.