Perioperative risk factors of preterm delivery after fetoscopic laser photocoagulation for twin-twin transfusion syndrome.

Abstract

To identify risk factors for preterm delivery (PTD) in patients who received fetoscopic laser photocoagulation (FLP) of placental anastomoses for twin-twin transfusion syndrome (TTTS). This retrospective cohort study prospectively analyzed and recorded perioperative data in a cohort of patients who had FLP for TTTS, identifying perioperative risk factors for PTD using a Cox proportional hazard regression model. Of 304 patients included, 26 (8.6%) delivered within 4weeks of FLP. Independent predictors of delivery within 4weeks of FLP were a history of PTD (hazard ratio [HR]: 5.91, 95% confidence interval [CI]:1.21-28.82, p=0.03), vaginal bleeding in the second trimester (HR: 6.62, 95% CI: 1.76-24.90, p<0.01), and amnioreduction ≥1715mL (HR: 3.16, 95% CI: 1.11-9.05, p<0.03). Patients with a history of PTD, preoperative vaginal bleeding, and amnioreduction ≥1715mL were more likely to deliver prematurely.