Clinical and biochemical predictors of very preterm birth in twin-to-twin transfusion syndrome treated by fetoscopy

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• 作者：Teresa Cobo ; Montse Palacio ; Elisenda Eixarch ; Fá ; tima Crispi ; Inma Mercadé ; Josep M. Mart&#xed ; nez-Crespo ; Eduard Gratacó ; s
• 关键词：me=""txt0010"">cervical lengthme=""txt0015""> ; CRPme=""txt0020""> ; fetoscopic therapyme=""txt0025""> ; IL-6me=""txt0030""> ; twin-to-twin transfusion syndrome
• 刊名：American Journal of Obstetrics and Gynecology
• 出版年：2011
• 出版时间：January 2011
• 年：2011
• 卷：204
• 期：1
• 页码：58.e1-58.e5
• 全文大小：198 K

文摘

Objective

To evaluate pre- and postoperative predictors of preterm birth in twin-to-twin transfusion syndrome treated with fetoscopic placental laser coagulation.

Study Design

Prospective cohort study (n = 166) assessing cervical length (pre and postoperatively), amniotic fluid interleukin-6, serum C-reactive protein and duration of surgery. Logistic regression was used to investigate associations with preterm delivery.

Results

Preterm delivery within 7 days, before 28.0 and 32.0 weeks occurred in 4.8 % , 16.8 % , and 28.9 % , respectively. The only significant predictor of delivery within 7 days was postoperative cervical length (odds ratio [OR], 0.5; 95 % confidence interval [CI], 0.3–0.9). Concerning delivery before 32.0 weeks, preoperative cervical length (OR, 0.9; 95 % CI, 0.8–1.0), and gestational age (OR, 0.8; 95 % CI, 0.4–0.9) were independent risk factors but the association was weak. The presence of a single survivor after surgery was associated with a clear reduction of risk (OR, 0.3; 95 % CI, 0.1–0.6). Inflammatory biomarkers and duration of surgery did not discriminate risk of prematurity.

Conclusion

No strong preoperative predictive factor of preterm birth could be identified. A single survivor was a strong protective factor of very preterm birth.