Clinical and biochemical predictors of very preterm birth in twin-to-twin transfusion syndrome treated by fetoscopy.
OBJECTIVE
To evaluate pre- and postoperative predictors of preterm birth in twin-to-twin transfusion syndrome treated with fetoscopic placental laser coagulation.


METHODS
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.


CONCLUSIONS
No strong preoperative predictive factor of preterm birth could be identified. A single survivor was a strong protective factor of very preterm birth.
Department of Maternal-Fetal Medicine, Hospital Clínic, Institute Clinic of Gynecology, Obstetrics, and Neonatology, Barcelona, Spain.
Teresa
T
Cobo
Montse
M
Palacio
Elisenda
E
Eixarch
Fátima
F
Crispi
Inma
I
Mercadé
Josep M
JM
Martínez-Crespo
Eduard
E
Gratacós
D000328:Adult; D000653:Amniotic Fluid / Q000737:chemistry*; D015415:Biomarkers / Q000032:analysis; D002097:C-Reactive Protein / Q000032:analysis*; D054791:Cervical Length Measurement / Q000379:methods; D005260:Female; D005330:Fetofetal Transfusion / Q000378:metabolism / Q000601:surgery; D005332:Fetoscopy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007231:Infant, Newborn; D015850:Interleukin-6 / Q000032:analysis*; D017075:Laser Coagulation / Q000379:methods; D016015:Logistic Models; D011247:Pregnancy; D047928:Premature Birth / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D011446:Prospective Studies; D012307:Risk Factors
D015415:Biomarkers; D015850:Interleukin-6; D002097:C-Reactive Protein