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Evolution of Stage 1 Twin-to-Twin Transfusion Syndrome (TTTS): Systematic Review and Meta-Analysis.

Khalil, A; Cooper, E; Townsend, R; Thilaganathan, B (2016) Evolution of Stage 1 Twin-to-Twin Transfusion Syndrome (TTTS): Systematic Review and Meta-Analysis. Twin Res Hum Genet, 19 (3). pp. 207-216. ISSN 1832-4274 https://doi.org/10.1017/thg.2016.33
SGUL Authors: Thilaganathan, Baskaran Khalil, Asma

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Abstract

OBJECTIVES: The natural history of stage 1 Twin-to-twin transfusion syndrome (TTTS) remains unclear and its optimal management is yet to be established. The main aims of this meta-analysis were to quantify the incidence of progression in stage 1 TTTS and to ascertain survival in these pregnancies. METHODS: MEDLINE, EMBASE, and The Cochrane Library were searched. Reference lists within each article were hand-searched for additional reports. The outcomes included incidence of progression and survival in stage 1 TTTS. Randomized controlled trials, cohort and case-control studies were included. Case reports, studies including three or fewer cases of stage 1 TTTS, and editorials were excluded. Proportion meta-analysis was used for analysis (Registration number: CRD42016036190). RESULTS: The search yielded 3,085 citations; 18 studies were included in the review (172 pregnancies to assess progression and 433 pregnancies to assess the survival). The pooled incidence of progression in stage 1 TTTS was 27% [95% CI 16-39%]. The pooled overall survival, double survival and at least one survival in the pregnancies managed expectantly were 79% [95% CI 62-92%], 70% [95% CI 54-84%] and 87% [95% CI 69-98%], respectively. In those undergoing amnioreduction, the corresponding figures were 77% [95% CI 68-85%], 67% [95% CI 57-76%] and 86% [95% CI 76-94%], respectively. The survival rates were 68% [95% CI 54-81%], 54% [95% CI 36-72%], and 81% [95% CI 69-90%], when laser surgery was performed. CONCLUSIONS: The optimal initial management of stage 1 TTTS remains in equipoise. The ongoing randomized trial comparing immediate laser surgery versus conservative management should provide a definitive answer.

Item Type: Article
Additional Information: © The Author(s) 2016
Keywords: TTTS, amniodrainage, conservative, laser, progression, stage 1, survival, twin-to-twin transfusion syndrome, Adult, Arteriovenous Anastomosis, Female, Fetofetal Transfusion, Humans, Placenta, Pregnancy, Pregnancy, Twin, Survival Rate, Twins, Monozygotic, twin-to-twin transfusion syndrome, TTTS, stage 1, progression, survival, laser, amniodrainage, conservative, TTTS, amniodrainage, conservative, laser, progression, stage 1, survival, twin-to-twin transfusion syndrome, Genetics & Heredity, 1114 Paediatrics And Reproductive Medicine, 1103 Clinical Sciences, 1702 Cognitive Science
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Academic Structure > Molecular and Clinical Sciences Research Institute (MCS) > Vascular (INCCVA)
Journal or Publication Title: Twin Res Hum Genet
ISSN: 1832-4274
Language: eng
Dates:
DateEvent
June 2016Published
3 May 2016Published Online
21 March 2016Accepted
Publisher License: Publisher's own licence
PubMed ID: 27137946
Web of Science ID: WOS:000377136600007
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/107912
Publisher's version: https://doi.org/10.1017/thg.2016.33

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