Fetoscopic laser photocoagulation versus expectant management for stage I twin-to-twin transfusion syndrome: A systematic review and meta-analysis |
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| Authors: | Ahmed A Nassr Kamran Hessami Nikan Zargarzadeh Eyal Krispin Shayan Mostafaei Mounira A Habli Ramesha Papanna Stephen P Emery Alireza A Shamshirsaz |
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| Institution: | 1. Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA;2. Maternal Fetal Care Center, Boston Children's Hospital, Harvard Medical Center, Boston, Massachusetts, USA;3. Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden;4. Department of Maternal-Fetal Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA;5. Department of Obstetrics, Gynecology and Reproductive Sciences, UT Health Science Center at Houston, Houston, Texas, USA;6. Department of Obstetrics and Gynecology, UPMC Magee Women's Hospital, Pittsburgh, Pennsylvania, USA |
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| Abstract: | To investigate the outcomes of asymptomatic stage I twin-to-twin transfusion syndrome (stage I TTTS) among patients treated with fetoscopic laser photocoagulation (FLP) versus expectant management. Databases such as PubMed, Web of Science and Scopus were systematically searched from inception up to March 1st, 2022. The primary outcome was at least one fetal survival at birth and secondary outcomes included gestational age at delivery, preterm premature rupture of membranes < 32 weeks, preterm birth < 32 weeks, and single and dual fetal survival. Five studies were included in the meta-analysis. There was no significant difference in terms of at least one survival (odds ratio (OR) = 1.40, 95%CI= (0.26, 7.43), P = 0.70), single survival (OR = 0.87, 95%CI= (0.51, 1.48), P = 0.60) and dual survival (OR = 1.63, 95%CI= (0.74, 3.62), P = 0.23) among FLP and expectant groups. Gestational age at delivery (mean difference = 1.19, 95%CI= (?0.25, 2.63), P = 0.10), the risk of PTB<32 weeks (OR = 0.88, 95%CI= (0.50, 1.54), P = 0.65), and pPROM<32 weeks (OR = 1.80, 95% CI= (0.41, 7.98), P = 0.44) were also comparable between the groups. Routine FLP of the placental anastomoses before 26 weeks of gestation is unlikely to be beneficial among asymptomatic stable stage I TTTS patients without cervical shortening as the procedure does not offer a survival advantage compared with expectant management. |
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