title: Iatrogenic Preterm Premature Rupture of Membranes after Fetoscopic Laser Ablative Surgery.
abstract: BACKGROUND
  To describe the incidence and risk factors for iatrogenic premature preterm rupture of membranes (iPPROM) after fetoscopic laser surgery for the twin-to-twin-transfusion syndrome.
  
  
  METHODS
  This is a retrospective review of all patients who have undergone fetoscopic laser surgery at a single fetal treatment center since 2000. We defined iPPROM as spontaneous rupture of membranes before the onset of labor prior to 34 weeks of gestation. The iPPROM cohort was compared to the cohort without iPPROM for several preoperative, operative, and delivery characteristics.
  
  
  RESULTS
  Ninety-two consecutive patients were reviewed. The overall rate of iPPROM was 18.5% (n = 17). The rates of iPPROM within 1 and 4 weeks were 5.4 and 10.9%, respectively. The median interval from surgery to delivery was significantly shorter in the iPPROM group (21 vs. 62 days, p = 0.01). The mean gestational age at delivery (27.0 vs. 31.1 weeks, p = 0.02) was lower in the iPPROM group. No other characteristics studied differed significantly between the groups.
  
  
  CONCLUSIONS
  The incidence of iPPROM was substantially lower than in recent multicenter reports; however, no risk factors of iPPROM could be identified. Whether this is related to variations in surgical or anesthetic management will require further investigation.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Women and Infants Hospital, Providence, R.I., USA.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Maggio
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Carr
authors.forename: Debra
authors.initials: D
authors.lastname: Watson-Smith
authors.forename: Barbara M
authors.initials: BM
authors.lastname: O'Brien
authors.forename: Vrishali
authors.initials: V
authors.lastname: Lopes
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Muratore
authors.forename: Francois I
authors.initials: FI
authors.lastname: Luks
mesh_terms: D000328:Adult; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000453:epidemiology* / Q000209:etiology*; D005330:Fetofetal Transfusion / Q000601:surgery*; D005332:Fetoscopy / Q000009:adverse effects*; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology; D015994:Incidence; D053685:Laser Therapy / Q000009:adverse effects*; D008297:Male; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult