329 Perinatal outcomes of pregnancies with iatrogenic chorioamniotic separation following fetal interventions: systematic review and meta-analysis

Abstract

This systematic review and meta-analysis aims to compare the perinatal outcomes of pregnancies with and without iatrogenic chorioamniotic separation (iCAS) after fetal interventions and to stratify the outcomes based on the indication for intervention. We performed a search in PubMed, Embase, Scopus, Web of Science and Google Scholar from inception up to August 2020 for studies evaluating perinatal variables among pregnancies developing iCAS after in utero fetal interventions. Inter-study heterogeneity was also assessed using the I2 statistic. Afterward, the random-effects model was used to pool the mean differences (MDs) or odds ratios (OR) and the corresponding 95% confidence intervals (CIs). Nine studies (total of 2,043 pregnancies) were included. Development of iCAS after fetal intervention is associated with significantly lower gestational age (GA) at the time of intervention (MD -0.80, 95% CI -1.58, -0.02), lower GA at delivery (MD -1.53, 95% CI: -2.67, -0.38) and lower neonatal survival (OR 0.48; 95% CI: 0.24, 0.93). In addition, iCAS significantly increased risks for preterm premature rupture of membranes (PPROM) < 37 weeks (OR 9.54; 95% CI: 3.97, 22.89), PPROM < 34 weeks (OR 3.94; 95% CI: 2.15, 7.23), preterm delivery < 32 weeks (OR 1.80; 95% CI: 1.16, 2.80) in this population (Figures A-H). Stratifying the patients based on the indication for intervention showed that development of iCAS is associated with lower GA at delivery (OR -1.74; 95% CI -3.13, -0.34, P 0.01) and lower neonatal survival (OR 0.41; 95% CI 0.24, 0.70) following fetal intervention for twin to twin transfusion syndrome (TTTS) but not for fetal myelomeningocele (fMMC) repair. iCAS is a common complication of fetal intervention that tends to develop more with earlier GA at intervention. iCAS is associated with earlier GA at delivery, higher risk of PPROM, preterm delivery before 32 weeks’ gestation and lower neonatal survival. On subgroup analysis, those risks were observed in patients who developed iCAS following fetal intervention for TTTS but not for fMMC.View Large Image Figure ViewerDownload Hi-res image Download (PPT)