title: Incidence and clinical implications of early inadvertent septostomy after laser therapy for twin-twin transfusion syndrome.
abstract: OBJECTIVE
  To evaluate the incidence and clinical outcome of inadvertent septostomy after fetoscopic laser therapy for twin-twin transfusion syndrome (TTTS) and, particularly, to explore its association with the risk of developing pseudoamniotic band syndrome (PABS).
  
  
  METHODS
  In a cohort of 414 consecutive monochorionic twin pregnancies with confirmed TTTS treated with laser, the incidence of postoperative septostomy within 1 week of the procedure was recorded prospectively. Rates of preterm delivery, preterm premature rupture of membranes (PPROM), intrauterine fetal demise (IUFD) and PABS were compared among cases with and without septostomy.
  
  
  RESULTS
  The mean gestational age at laser therapy was 20.4 (range, 15.3-27.6) weeks. Postoperative septostomy occurred in 30 (7.2%) cases. Pregnancies complicated with septostomy had a significantly higher proportion of preterm delivery before 32 weeks (76.7% vs. 30.2%, P < 0.001), PPROM before 32 weeks (46.7% vs. 19.0%, P < 0.001), IUFD (43.3% vs. 25.8%, P < 0.05) and PABS (13.3% vs. 1.0%, P < 0.001), compared with pregnancies without septostomy.
  
  
  CONCLUSIONS
  Inadvertent septostomy occurred in 7% of cases after fetoscopic laser therapy and was associated with a substantially increased risk of adverse perinatal outcome and PABS.
authors: Department of Maternal-Fetal Medicine, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
authors: R
authors: R
authors: Cruz-Martinez
authors: T
authors: T
authors: Van Mieghem
authors: L
authors: L
authors: Lewi
authors: E
authors: E
authors: Eixarch
authors: T
authors: T
authors: Cobo
authors: J M
authors: JM
authors: Martinez
authors: J
authors: J
authors: Deprest
authors: E
authors: E
authors: Gratacos
mesh_terms: D000293:Adolescent; D000328:Adult; D000652:Amniotic Band Syndrome / Q000000981:diagnostic imaging / Q000209:etiology*; D002823:Chorion / Q000098:blood supply*; D005260:Female; D005330:Fetofetal Transfusion / Q000000981:diagnostic imaging / Q000601:surgery; D005332:Fetoscopy / Q000009:adverse effects*; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007234:Infant, Premature; D053685:Laser Therapy / Q000009:adverse effects*; D011183:Postoperative Complications; D011247:Pregnancy; D018570:Risk Assessment; D016896:Treatment Outcome; D014463:Ultrasonography; D055815:Young Adult