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Association of amnioinfusion volume at the time of surgery for twin-twin transfusion syndrome and latency to delivery |
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| Authors: | Braxton Forde Foong-Yen Lim David N McKinney Mounira Habli Kara B Markham Mallory Hoffman Sammy Tabbah Marc Oria Jose L Peiro |
| Institution: | 1. Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA;2. Fetal Care Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
Division of General and Thoracic Surgery, Department of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA;3. Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA Fetal Care Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA;4. Fetal Care Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, TriHealth Health System, Cincinnati, Ohio, USA;5. Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, TriHealth Health System, Cincinnati, Ohio, USA Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Riverside Methodist Hospital, Cincinnati, Ohio, USA;6. Division of General and Thoracic Surgery, Department of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA |
| Abstract: | ObjectiveTo evaluate the impact of amnioinfusion and other peri-operative factors on pregnancy outcomes in the setting of Twin-twin transfusion syndrome (TTTS) treated via fetoscopic laser photocoagulation (FLP).MethodsRetrospective study of TTTS treated via FLP from 2010 to 2019. Pregnancies were grouped by amnioinfusion volume during FLP (<1 L vs. ≥1 L). The primary outcome was latency from surgery to delivery. An amnioinfusion statistic (AIstat) was created for each surgery based on the volume of fluid infused and removed and the preoperative deepest vertical pocket. Regression analysis was planned to assess the association of AIstat with latency.ResultsPatients with amnioinfusion of ≥1 L at the time of FLP had decreased latency from surgery to delivery (61 ± 29.4 vs. 73 ± 28.8 days with amnioinfusion <1 L, p < 0.001) and increased preterm prelabor rupture of membranes (PPROM) <34 weeks (44.7% vs. 33.5%, p = 0.042). Amnioinfusion ≥1 L was associated with an increased risk of delivery <32 weeks (aRR 2.6, 95% CI 1.5–4.5), 30 weeks (aRR 2.4, 95% CI 1.5–3.8), and 28 weeks (aRR 1.9, 95% CI 1.1–2.3). Cox-proportional regression revealed that AIstat was inversely associated with latency (HR 1.1, 95% CI 1.1–1.2).ConclusionAmnioinfusion ≥1 L during FLP was associated with decreased latency after surgery and increased PPROM <34 weeks. |
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