Management of twin-twin transfusion syndrome with an extremely short cervix.

Journal: Journal Of Obstetrics And Gynaecology : The Journal Of The Institute Of Obstetrics And Gynaecology
Treatment Used: Laser Surgery and Cerclage
Number of Patients: 17
Published:
MediFind Summary

Summary: This study described the management and perinatal outcomes of patients with twin-twin transfusion syndrome (TTTS) and an extremely short cervical length (CL).

Conclusion: This study demonstrates that laser surgery and cerclage placement in such patients are not only technically feasible, but also can result in favorable perinatal outcomes. Patients with an extremely short cervical length should not be uniformly excluded from laser surgery for twin-twin transfusion syndrome.

Abstract

The objective of this study was to describe the management and perinatal outcomes of patients with twin-twin transfusion syndrome (TTTS) and an extremely short cervical length (CL). This retrospective study examined 17 patients with TTTS and a preoperative CL ≤1.0 cm who had undergone laser surgery and perioperative cervical cerclage placement successfully. In this subset of patients, the median interval between surgery and delivery was 9.6 (range 2.1-13.9) weeks and only one patient had PPROM within 3 weeks of surgery. The median gestational age at delivery was 30.9 (range 23.1-37.6) weeks, 30-day survival of at-least-one twin was 88.2% and dual survivorship was 82.4%. Overall, patients with TTTS and a preoperative CL ≤1.0 cm who were able to undergo successful laser surgery and emergent cerclage placement had favourable outcomes. Impact statement The management of patients with twin-twin transfusion syndrome (TTTS) and extremely short cervical length (CL) varies between foetal surgery centres. This study demonstrates that laser surgery and cerclage placement in such patients are not only technically feasible, but also can result in favourable perinatal outcomes. Patients with an extremely short CL should not be uniformly excluded from laser surgery for TTTS.

Authors
Myrna Aboudiab, Andrew Chon, Lisa Korst, Arlyn Llanes, Joseph Ouzounian, Ramen Chmait

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