Abstract:
BACKGROUND:To evaluate the incidence and outcomes of septostomy in twin-to-twin transfusion syndrome (TTTS) after fetoscopic laser therapy. METHODS:A retrospective analysis of TTTS postlaser septostomy between 2005 and 2018 was performed. Postlaser septostomy was diagnosed using both (1) a free-floating intertwin membrane flap visible on ultrasound examination and (2) the rapid equalization of amniotic fluid maximum vertical pocket in the donor and recipient amniotic sacs observed after laser therapy. Perinatal survival, neonatal brain image anomaly, gestational age at operation and birth, incidence of premature rupture of membranes (PROM) within 3 weeks after operation, pseudoamniotic band syndrome, and cord entanglement were evaluated. RESULTS:In the 159 TTTS cases included, 12 had postlaser septostomy. Relative to the group without septostomy, the septostomy group had a lower total fetal survival rate (54.2% vs 73.6%, p = 0.041), an earlier mean gestational age at delivery (27.8 vs 34.4 weeks, p = 0.009), a higher risk of PROMs within 3 weeks after operation (33.3% vs 5.4%, p = 0.004), a higher cord entanglement rate (16.7% vs 0%, p = 0.005), and a higher brain image anomaly rate (23.0% [3/13] vs 5.0% [11/218], p = 0.035). After considering the severe Quintero stages (stage III and IV), postlaser septostomy was the only variable [p = 0.003, odds ratio = 5.1] to predict neonatal brain image anomaly. Postlaser septostomy combined with severe Quintero stages could predict PROMs within 3 weeks after laser therapy [p = 0.001, odds ratio = 14.1 and p = 0.03, odds ratio = 5.4, respectively] and delivery before the gestational age of 28 weeks [p = 0.017, odds ratio = 4.5 and p = 0.034, odds ratio = 2.3, respectively]. The risk of pseudoamniotic band syndrome was not increased by postlaser septostomy in this case series. CONCLUSIONS:Postlaser septostomy in TTTS was associated with poorer fetal survival and more adverse perinatal outcomes even after considering severe Quintero stages before laser therapy. Efforts should be made to prevent septostomy during laser therapy, and septostomy as the primary method to treat TTTS is not advisable.
journal_name
BMC Pregnancy Childbirthjournal_title
BMC pregnancy and childbirthauthors
Li WF,Chao AS,Chang SD,Cheng PJ,Yang LY,Chang YLdoi
10.1186/s12884-019-2555-5subject
Has Abstractpub_date
2019-11-01 00:00:00pages
397issue
1issn
1471-2393pii
10.1186/s12884-019-2555-5journal_volume
19pub_type
杂志文章abstract:BACKGROUND:Skilled attendants during labor, delivery, and in the early postpartum period, can prevent up to 75% or more of maternal death. However, in many developing countries, very few mothers make at least one antenatal visit and even less receive delivery care from skilled professionals. The present study reports f...
journal_title:BMC pregnancy and childbirth
pub_type: 杂志文章
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journal_title:BMC pregnancy and childbirth
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doi:10.1186/1471-2393-14-296
更新日期:2014-08-30 00:00:00
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journal_title:BMC pregnancy and childbirth
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journal_title:BMC pregnancy and childbirth
pub_type: 杂志文章,随机对照试验
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journal_title:BMC pregnancy and childbirth
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journal_title:BMC pregnancy and childbirth
pub_type: 杂志文章
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journal_title:BMC pregnancy and childbirth
pub_type: 杂志文章,随机对照试验
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journal_title:BMC pregnancy and childbirth
pub_type: 杂志文章
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journal_title:BMC pregnancy and childbirth
pub_type: 杂志文章,评审
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journal_title:BMC pregnancy and childbirth
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journal_title:BMC pregnancy and childbirth
pub_type: 杂志文章,多中心研究
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journal_title:BMC pregnancy and childbirth
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journal_title:BMC pregnancy and childbirth
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journal_title:BMC pregnancy and childbirth
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更新日期:2019-11-19 00:00:00
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journal_title:BMC pregnancy and childbirth
pub_type: 杂志文章,随机对照试验
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journal_title:BMC pregnancy and childbirth
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journal_title:BMC pregnancy and childbirth
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journal_title:BMC pregnancy and childbirth
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journal_title:BMC pregnancy and childbirth
pub_type: 杂志文章,评审
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journal_title:BMC pregnancy and childbirth
pub_type: 杂志文章
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更新日期:2021-01-28 00:00:00
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journal_title:BMC pregnancy and childbirth
pub_type: 杂志文章
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更新日期:2019-11-21 00:00:00
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journal_title:BMC pregnancy and childbirth
pub_type: 杂志文章
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更新日期:2016-07-04 00:00:00
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journal_title:BMC pregnancy and childbirth
pub_type: 杂志文章
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journal_title:BMC pregnancy and childbirth
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更新日期:2020-01-08 00:00:00
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journal_title:BMC pregnancy and childbirth
pub_type: 杂志文章,评审
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journal_title:BMC pregnancy and childbirth
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更新日期:2021-01-07 00:00:00
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journal_title:BMC pregnancy and childbirth
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abstract:BACKGROUND:Fear of childbirth is a common health concern for women during pregnancy. The Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) is widely used to measure childbirth fear during pregnancy. However, this instrument is yet to be validated in Malawi, Africa. Our study aimed to assess the psychometric pr...
journal_title:BMC pregnancy and childbirth
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