Pregnancy Outcomes Of Different Treatments For Twin To Twin Transfusion Syndrome

ObjectiveTo compare the pregnancy outcomes of three different treatment methods of twin to twin transfusion syndrome(TTTS),expectant therapy,fetal endoscopic laser photocoag ulation of communicating vessels and fetal reduction,and to explore the best treatment methods for different Quintero stages of TTTS.Methods1.A total of 68 pregnant women with twin transfusion syndrome from January 1,2010to December 31,2020 in Yang Zhou area were selected.According to different treatment methods,they were divided into expectant treatment group(n=24),fetuscopic laser treatment group(n=35)and fetal reduction group(n=9).Installment according to TTTS standard,it can be divided into four sessions,including TTTSⅠperiod 24 cases,Ⅱphase of the 23 cases,Ⅲperiod in 11 cases,10 casesⅣperiod..Collecting basic information and maternal and infant pregnancy outcomes of the three groups and SPSS 24.0 software was used for statistical analysis of the data.2.Search Wanfang,VIP,CNKI,Chinese Biomedical Literature Database,Pub Med,Web of Science,Geen Medical and other Chinese and English databases.Retrieval time are built from library to 2020.12.31,according to include and exclude criteria to filter the retrieved literature,adopting the Cochrane handbook on bias risk standard for quality evaluation,to extract the basic information and research literature related to observe.Using Stata SE15,Review Manager 5.4 software to do meta analysis,comparing the pregnancy outcome of fetal reduction and fetal endoscopic laser treatment.Result1.Comparison of pregnancy outcomes of 68 pregnant women with twin transfusion syndrome in XX area:(1)There were no statistical differences in age,height,weight,gestational age at diagnosis and gestational mode among the 3 groups(P>0.05).In three kinds of treatments of TTTS stages than in patients with stageⅠandⅡtreatment,was statistically difference(X~2=7.654~a,P=0.022;X~2=9.749,P=0.008),stageⅢandⅣpatients treatment,no statistical difference(P>0.05),(2)laser total survival rate is higher than the other two groups,treatment group was statistically difference(X~2=9.269~a,P=0.010),three groups of patients with single embryo survival rate,at least one child survival is no statistical difference(P>0.05).TTTSⅡmidterm,laser treatment group total survival and at least one embryo survival rate is higher,there are statistically significant(X~2=9.763,P=0.008;X~2=5.330,P=0.048),TTTSⅢmidterm,single embryo survival rate is higher,reduction surgery group was statistically significant(X~2=6.299,P=0.043),more than TTTSⅠ～Ⅳcompared fetal survival situation,there were no statistically significant difference(P>0.05).(3)Fetal reduction group could effectively prolong the gestational period,and the difference was statistically significant(F=3.642,P=0.041).There were no statistically significant differences in preterm delivery,premature rupture of membranes and postpartum bleeding at<34 weeks(P>0.05).TTTSⅠmidterm,fetal loss childbirth pregnant weeks,compared with other two groups significantly extended,the difference was statistically significant(F=4.113,P=0.038),more than TTTSⅠ～Ⅳperiod pregnancy outcome of comparison,there were no statistical differences(P>0.05).(4)reduction surgery cesarean delivery rate is lower than the other two groups,statistically significant(X~2=6.080,P=0.048),TTTSⅠ～Ⅳperiod patients of childbirth way within the group comparison,there were no statistical differences(P>0.05).(5)The neonatal weight of the reduction group was higher than that of the other two groups,with statistical difference(F=3.869,P=0.034).The rate of neonatal nervous system injury in the expectant treatment group was higher than that in the other two groups,with statistical difference(X~2=6.155,P=0.046).There was no statistical difference in neonatal asphyxia and neonatal infection(P>0.05).TTTSⅡperiod to the treatment group of neonatal neurological damage rate is higher,the difference was statistically significant(X~2=5.884,P=0.048),more than TTTSⅠ～Ⅳphase comparison of newborns is no statistical difference(P>0.05).2.Results of meta-analysis:(1)15 references were included;(2)The overall survival rate of the fetuses treated with fetal endoscopic laser group(OR:1.77,95%CI:1.60,1.96)was higher than that treated with fetal reduction group(OR:1.45,95%CI:1.39,1.52);(3)The survival rate of at least one fetus in the fetal endoscopic laser group(OR:2.04,95%CI:1.83,2.28)was higher than fetal reduction group(OR:2.02,95%CI:1.89,2.15);(4)The survival rate of single fetus in the fetal reduction group(OR:2.02,95%CI:1.89,2.15)was higher than that in the fetal endoscopic laser group(OR:1.28,95%CI:1.19,1.37);(5)The intrauterine rate of fetal death in the fetal reduction group(OR:1.12,95%CI:1.07,1.34)was lower than that in the fetal endoscopic laser group(OR:1.13,95%CI:1.05,1.23);(6)The abortion rate of the fetal reduction group(OR:1.18,95%CI:1.10,1.26)was lower than that of the fetal endoscopic laser group(OR:1.21,95%CI:1.11,1.32);(7)The rate of premature rupture of membranes in the fetal laser coagulation group(OR:1.14,95%CI:1.06,1.24)was lower than that in the fetal endoscopic laser group(OR:1.15,95%CI:0.99,1.32).Conclusions1.For patients at 16-26 weeks of gestation,fetal endoscopic placental vascular laser coagulation is the preferred method,which can effectively increase fetal survival rate and significantly reduce the rate of neonatal nervous system injury.2.For TTTSⅠperiod patients,especially those with more than 26 weeks of pregnancy,can treat in closely monitoring downward look forward to,as far as possible to extend gestational age,if the disease progression,are completed to promote fetal lung maturity,on the basis of selecting the appropriate time to terminate pregnancy.3.Fatal reduction surgery is mainly for patients with severe deformities in one of the twins,cerebral nerve damage,or low estimated postnatal survival,who cannot undergo FLP surgery.Its advantage is to extend the gestational week of delivery appropriately,reduce the occurrence of cesarean section and premature rupture of membranes.