335 Perinatal outcome of twin-to-twin-transfusion syndrome complicated with incidental septostomy after laser-surgery: systematic review and meta-analysis

Abstract

This systematic review and meta-analysis aimed to evaluate the perinatal outcomes of incidental septostomy after laser therapy for twin-to-twin transfusion syndrome (TTTS), and to compare the outcomes with those who had intact intertwin membrane. Databases such as PubMed, Web of Science, Scopus, and Embase were systematically searched from inception up to August 2020. Inter-study heterogeneity was also assessed using Cochrane’s Q test and the I2 statistic. Afterward, the random-effects model was used to pool the mean difference (MD) or odds ratio (OR) with the corresponding 95% confidence intervals (CIs). The primary outcome was neonatal survival while secondary outcomes included gestational age at intervention, gestational age at delivery, preterm delivery, preterm premature rupture of membranes (PPROM). Four studies (1442 TTTS patients) met our study’s inclusion criteria. Gestational age (GA) at the time of laser surgery was significantly higher among those who developed septostomy (MD = 0.90; 95% CI, 0.30, 1.51; P = 0.003). Postoperative identification of incidental septostomy was associated with earlier GA at delivery (MD = -2.52; 95% CI, -3.22, -1.82; P <0.00), significantly higher risk of PPROM <32 weeks (OR = 2.82; 95% CI, 1.80, 4.40; P <0.001) and preterm delivery <32 weeks (OR = 4.01; 95% CI, 1.27, 12.63; P =0.02). No differences were noted in pseudoamniotic band syndrome (OR = 3.17; 95% CI, 0.28, 35.55; P =0.35; I2= 66.0%), at least one neonatal survival (OR = 0.47; 95% CI, 0.19, 1.13; P =0.09; I2= 52.0%) or dual neonatal survival rate (OR = 0.69; 95% CI, 0.36, 1.31; P =0.25; I2= 0.0%) between septostomy and non-septostomy groups (Figures A-G). Incidental septostomy following laser photocoagulation for TTTS tends to develop more with advanced GA at the time for intervention. It is associated with earlier GA at delivery, increased risk for PPROM and preterm delivery < 32 weeks’ gestation. However, neonatal survival does not appear to be affected by this complication.View Large Image Figure ViewerDownload Hi-res image Download (PPT)