Chorioamniotic Membrane Separation after Fetoscopic Laser Photocoagulation
Chorioamniotic Membrane Separation after Fetoscopic Laser Photocoagulation
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DOI：
10.1159/000472713
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发表时间：
2018-01-01
影响因子：
2.2
通讯作者：
Morita, Mineto
中科院分区：
文献类型：
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作者：
Takano, Mayumi;Nakata, Masahiko;Morita, Mineto
简介：本研究旨在探讨胎儿镜下激光光凝术（FLP）后绒毛膜羊膜分离（CMS）的危险因素、发生率及其对围产儿结局的影响。材料和方法：本回顾性研究包括312名因双胎输血综合征（TTTS）接受FLP的妇女。临床记录用于审查产科检查，并发症，手术数据，超声检查结果，围产期和新生儿随访数据的所有患者。结果：共分析260例TTTS。CMS发生率为12.7%（33例）。CMS的唯一独立危险因素是在胎龄（GA）20周之前进行FLP（比值比= 3.38 [1.44-7.93]，p = 0.005）。关于围产期结局，CMS仅与32周前胎膜早破（PROM）风险增加相关（33.3%对13.9%，p = 0.005），分娩时GA和存活率无差异。讨论：在我们的队列中，FLP后CMS的发生率约为13%，20周前手术是唯一确定的风险因素。虽然在我们的人群CMS并没有恶化围产期结局早产或生存，早产胎膜早破率增加，这应该考虑到患者的管理。(C)2017 S. Karger AG，巴塞尔
Introduction: This study aimed to investigate the risk factors, incidence, and influence on the perinatal outcome of chorioamniotic membrane separation (CMS) after fetoscopic laser photocoagulation (FLP). Material and Methods: This retrospective study included 312 women who underwent FLP for twin-to-twin transfusion syndrome (TTTS). Clinical records were used to review obstetrical examinations, complications, operative data, ultrasonographic findings, and perinatal and neonatal follow-up data in all patients. Results: A total of 260 cases of TTTS were analyzed. The incidence of CMS was 12.7% (33 cases). The only independent risk factor of CMS was performing FLP before 20 weeks of gestational age (GA) (odds ratio = 3.38 [1.44-7.93], p = 0.005). Concerning perinatal outcome, CMS was only related with increased risk of premature rupture of membranes (PROM) before 32 weeks (33.3 vs. 13.9%, p = 0.005), with no differences in GA at delivery and survival rate. Discussion: In our cohort, the incidence of CMS after FLP was approximately 13%, with surgery before 20 weeks being the only risk factor identified. Although in our population CMS did not worsen perinatal outcome in terms of preterm delivery or survival, the preterm PROM rate was increased and this should be considered for the patients' management. (C) 2017 S. Karger AG, Basel