Fetal Diagnosis and Therapy
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Article / Publication Details
Abstract
\
Introduction:
Chorioamnion separation (CAS), preterm prelabor rupture of membranes (PPROM), and preterm delivery (PTD) remain major complications of fetoscopic laser photocoagulation (FLP) for twin-to-twin transfusion syndrome (TTTS). We sought to examine whether use of quincke-tip needles for initial entry in FLP reduces the risk of these complications.
Methods:
This is a secondary analysis of prospectively collected data from patients that had FLP for TTTS at a single tertiary care center (2011 – 2021). We excluded patients for whom direct trocar entry was used. Patients for whom a quincke-tip needle, versus a diamond-tip needle was used for Seldinger entry were compared. Demographics, ultrasound findings and operative characteristics were compared between groups. Post-operative outcomes and complications (including CAS, PPROM and PTD) were also compared. Multivariate logistic regression models were fit to assess independent risk factors for complications.
Results:
386 patients met inclusion criteria; quincke-tip needles were used in 81 (21.0%) cases while diamond-tip needles were used in 305 (79.0%). Rates of CAS (11.1% vs 9.5%, p = 0.67) and PPROM (44.4% vs 41.0%, p = 0.57) were similar between groups. Patients in the quincke-tip group delivered 1.5 weeks earlier than those in the diamond-tip group (30.5 vs 32.0 weeks, p = 0.01). However, these patients were more likely to be delivered for maternal (35.9% vs. 19.0%) and fetal (23.1% vs. 15.3%) indications (p
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