SORA

Advancing, promoting and sharing knowledge of health through excellence in teaching, clinical practice and research into the prevention and treatment of illness

Outcome of twin-to-twin transfusion syndrome in monochorionic monoamniotic twin pregnancies: a systematic review and meta-analysis.

Murgano, D; Khalil, A; Prefumo, F; Van Mieghem, T; Rizzo, G; Heyborne, KD; Melchiorre, K; Peeters, S; Lewi, L; Familiari, A; et al. Murgano, D; Khalil, A; Prefumo, F; Van Mieghem, T; Rizzo, G; Heyborne, KD; Melchiorre, K; Peeters, S; Lewi, L; Familiari, A; Lopriore, E; Oepkes, D; Murata, M; Anselem, O; Buca, D; Liberati, M; Hack, K; Nappi, L; Baxi, LV; Scambia, G; Acharya, G; D'Antonio, F (2020) Outcome of twin-to-twin transfusion syndrome in monochorionic monoamniotic twin pregnancies: a systematic review and meta-analysis. Ultrasound Obstet Gynecol, 55 (3). pp. 310-317. ISSN 1469-0705 https://doi.org/10.1002/uog.21889
SGUL Authors: Khalil, Asma

[img] PDF Published Version
Restricted to Repository staff only until 2 March 2021.
Available under License ["licenses_description_publisher" not defined].

Download (2MB)

Abstract

Objectives To explore the outcome of monochorionic monoamniotic (MCMA) twin pregnancies affected by twin‐to‐twin transfusion syndrome (TTTS). Methods MEDLINE and EMBASE databases were searched for studies reporting the outcome of MCMA twin pregnancies complicated by TTTS. The primary outcome was intrauterine death (IUD); secondary outcomes were miscarriage, single IUD, double IUD, neonatal death (NND), perinatal death (PND), survival of at least one twin, survival of both twins and preterm birth (PTB) before 32 weeks' gestation. Outcomes were assessed in MCMA twins affected by TTTS not undergoing intervention and in those treated with amniodrainage, laser therapy or cord occlusion. Subgroup analysis was performed including cases diagnosed before 24 weeks. Random‐effects meta‐analysis of proportions was used to analyze the data. Results Fifteen cohort studies, including 888 MCMA twin pregnancies, of which 44 were affected by TTTS, were included in the review. There was no randomized trial comparing the different management options in MCMA twin pregnancies complicated by TTTS. In cases not undergoing intervention, miscarriage occurred in 11.0% of fetuses, while the incidence of IUD, NND and PND was 25.2%, 12.2% and 31.2%, respectively. PTB complicated 50.5% of these pregnancies. In cases treated by laser surgery, the incidence of miscarriage, IUD, NND and PND was 19.6%, 27.4%, 7.4% and 35.9%, respectively, and the incidence of PTB before 32 weeks' gestation was 64.9%. In cases treated with amniodrainage, the incidence of IUD, NND and PND was 31.3%, 13.5% and 45.7% respectively, and PTB complicated 76.2% of these pregnancies. Analysis of cases undergoing cord occlusion was affected by the very small number of included cases. Miscarriage occurred in 19.2%, while there was no case of IUD or NND of the surviving twin. PTB before 32 weeks occurred in 50.0% of these cases. Conclusions MCMA twin pregnancies complicated by TTTS are at high risk of perinatal mortality and PTB. Further studies are needed in order to elucidate the optimal type of prenatal treatment in these pregnancies.

Item Type: Article
Additional Information: This is the peer reviewed version of the following article: Murgano, D., Khalil, A., Prefumo, F., Mieghem, T.V., Rizzo, G., Heyborne, K.D., Melchiorre, K., Peeters, S., Lewi, L., Familiari, A., Lopriore, E., Oepkes, D., Murata, M., Anselem, O., Buca, D., Liberati, M., Hack, K., Nappi, L., Baxi, L.V., Scambia, G., Acharya, G. and D'antonio, F. (2020), Outcome of twin‐to‐twin transfusion syndrome in monochorionic monoamniotic twin pregnancy: systematic review and meta‐analysis. Ultrasound Obstet Gynecol, 55: 310-317, which has been published in final form at https://doi.org/10.1002/uog.21889. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.
Keywords: TTTS, monochorionic monoamniotic, twin pregnancies, 1114 Paediatrics And Reproductive Medicine, Obstetrics & Reproductive Medicine
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: Ultrasound Obstet Gynecol
ISSN: 1469-0705
Language: eng
Dates:
DateEvent
2 March 2020Published
8 October 2019Published Online
18 September 2019Accepted
Publisher License: Publisher's own licence
PubMed ID: 31595578
Go to PubMed abstract
URI: http://openaccess.sgul.ac.uk/id/eprint/111313
Publisher's version: https://doi.org/10.1002/uog.21889

Actions (login required)

Edit Item Edit Item