Background: Twin-to-twin transfusion syndrome (TTTS) is one of the most severe complications of monochorionic diamniotic (MCDA) twin pregnancies, with an estimated incidence of 10%-15%. Timely diagnosis and treatment of TTTS are crucial to maximize perinatal outcome. In fact, TTTS is usually diagnosed in the second trimester with oligo/polyhydramnios sequence. Prenatal intervention includes fetoscopic laser therapy of placental anastomoses, which is more effective than serial amnioreduction before 26 weeks. Improved surgical experience and improvement in technical equipment and image quality has led to a significant reduction in perinatal mortality and neurological morbidity. This complication can occur not only in MCDA pregnancies but also in higher order pregnancies such as triplets with a monochorionic component. Furthermore, this can occur also at “unconventional” gestational ages such as before 18 weeks, i.e. “early TTTS”, or after 26 weeks, i.e. In “late TTTS”. The aim of this multicenter retrospective study was to report on perinatal outcomes of multiple pregnancies complicated by TTTS. Methods: This was a multicenter retrospective cohort study including multiple pregnancies with a monochorionic component managed in 21 participating centers around the world from 2007 onwards. The project analyzed data on monochorionic triplet pregnancies and twin complicated by “unconventional” TTTS. Data on maternal age, mode of conception, diagnosis of major fetal structural anomalies or aneuploidy, gestational age (GA) at diagnosis of anoma-lies, twin-to-twin transfusion syndrome (TTTS), twin anemia – polycythemia sequence (TAPS), twin reversed arterial perfusion (TRAP) sequence and or selective fetal growth restriction (sFGR) were retrieved from patient records. Data on antenatal interventions were collected, including data on selective fetal reduction (three to two or three to one for triplets), laser surgery and any other active fetal intervention (including amniodrainage). Data on perinatal outcome were collected, including numbers of livebirth, intrauterine demise, neonatal death, perinatal deathand termination of fetus or pregnancy (TOP). Neonatal data such as GA at birth, birth weight, admission to neonatal intensive care unit and neonatal morbidity were also collected. Perinatal outcomes were assessed according to whether the pregnancy was managed expectantly or underwent fetal intervention. Results and expected results: In our cohort of MCTA triplet pregnancies (n=153 after excluding early miscarriages, TOP and loss to follow-up), the majority (90%) were managed expectantly. The incidence of fetal abnormalities and TRAP was 13.7% and 5.2%, respectively. The most common antenatal complication related to chorionicity was TTTS, which complicated just over a quarter (27.6%) of the pregnancies, followed by sFGR (16.4%), while TAPS (both spontaneous and post-laser) occurred in only 3.3%; no antenatal complication was recorded in 49.3% of pregnancies. Survival was largely associated with the development of these complications: 85.1%, 100% and 47.6% of pregnancies had at least one surviving newborn in those without antenatal complications, complicated by sFGR, or complicated by TTTS, respectively. The overall rates of preterm birth < 28 weeks and <32 weeks’ gestation were 14.5% and 49.2%, respectively. For “unconventional” TTTS, we aim to assess the fetal and perinatal outcomes of twin pregnancies complicated by TTTS and neonatal morbidity. Conclusion: Monochorionicity-related complications can impact adversely perinatal outcome in multiple pregnancies creating a challenge with regard to counseling, surveillance and management.

Background: La trasfusione feto-fetale (TTTS) è una delle più gravi complicanze delle gravidanze gemellari monocoriali (MCDA), con una incidenza stimata del 10-15%. La diagnosi precoce e il trattamento della TTTS sono cruciali per massimizzare gli outcome perinatali. Infatti, la TTTS è generalmente diagnosticata nel secondo trimestre con la sequenza “oligo/polidramnios”. Gli interventi disponibili in epoca prenatale includono il trattamento fetoscopico mediante laser delle anastomosi placentari. I miglioramenti nelle tecniche chirurgiche, nello strumentario disponibile e nella qualità dell’imaging hanno permesso una riduzione significativa della mortalità perinatale e della morbidità neurologica. Questa complicanza può verificarsi non solo nelle gravidanze MCDA ma anche in gravidanze trigemine con una componente monocoriale. Inoltre, e ad epoche gestazionali “non convenzionali” e cioè prima delle 18 settimane nei casi di “early TTTS” o dopo le 26 settimane nei casi di “late TTTS”. Lo scopo di questo studio multicentrico retrospettivo è quello di riportare dati sugli outcomes perinatale di gravidanze multiple complicate da TTTS. Metodi: questo è uno studio multicentrico retrospettivo di coorte che include gravidanze multiple con una componente monocoriale proveniente da 21 centri partecipanti in tutto il mondo dal 2007 in poi. Il progetto vuole analizzare dati sulle gravidanze trigemine monocoriali o gemellari monocoriali complicate da TTTS ad epoche non convenzionali. Dati su età materna, modalità di concepimento, diagnosi di anomali strutturali o aneuploidie, epoca gestazionale alla diagnosi delle anomalie, TTTS, sequenza anemia-policitemia (TAPS), sequenza twin reversed arterial perfusion (TRAP) e restrizione di crescita selettiva (sFGR) sono stati raccolti dalle cartelle cliniche, incluso dati sulla riduzione selettiva fetale (da tre a due o da tre a uno nelle trigemenine), dati sul laser o altri tipi di interventi fetali attivi incluso l’amniodrenaggio. Dati sugli outcome perinatali sono stati altresì raccolti, incluso numero di nati vivi, morti fetali neonatali, terminazioni volontarie di gravidanza, ammissione in terapia intensiva neonatale ecc. Questi outcomes sono stati analizzati in base al tipo di management scelto (expectant o interventistico). Risultati e risultati attesi: nella nostra coorte di trigemine a componente monocoriale (N=153 esclusi aborti precooci, interruzioni e perdite al follow-up), la maggior parte sono stati gestiti con expectant. L’incidenza di anomalie o TRAP è stata 13.7% e 5.2%, rispettivamente. La TTTS ha complicato il 27.6% delle gravidanze seguita da sFGR (16.4%),mentre la TAPS (spontanea and post-laser) si è verificata in solo lo 3.3%; nessuna complicanza è stata registrata nel 49.3%. Lça sopravvivenza è dipesa dallo sviluppo di complicanze 85.1%, 100% e 47.6% delle gravidanze con un gemello che sopravvive nelle gravidanze senza complicanze, con sFGR o TTTS rispettivamente. Il tasso di parto pretermine prima di 28 settimane e prima di 32 sono 14.5% e 49.2%, rispettivamente. Per le TTTS non convenzionali ci proponiamo di valutare tasso di complicanze fetali e perinatali, tasso di progression di TTTS in forme più severe, di complicnze aggiuntive quali sFGR, TAPS o rottura premature delle membrane dopo procedura laser. Infine, valuteremo morbidità neonatale quale distress respiratorio, ammissione in terapia intensive neonatale, presenza di emorragie intraventricolari o leukomalacia periventricolare all’imaging. Conclusioni: Le complicanze legate alla monocorionicità impattano negativamente sulle gravidanze multiple e pertanto rappresentano una sfia per il clinic nel counseling, sorveglianze e gestione.

Outcome perinatali di gravidanze gemellari monocoriali complicate dalla sindrome feto fetale / Filomena Giulia Sileo , 2024 Sep 27. 36. ciclo, Anno Accademico 2022/2023.

Outcome perinatali di gravidanze gemellari monocoriali complicate dalla sindrome feto fetale.

Sileo, Filomena Giulia
2024

Abstract

Background: Twin-to-twin transfusion syndrome (TTTS) is one of the most severe complications of monochorionic diamniotic (MCDA) twin pregnancies, with an estimated incidence of 10%-15%. Timely diagnosis and treatment of TTTS are crucial to maximize perinatal outcome. In fact, TTTS is usually diagnosed in the second trimester with oligo/polyhydramnios sequence. Prenatal intervention includes fetoscopic laser therapy of placental anastomoses, which is more effective than serial amnioreduction before 26 weeks. Improved surgical experience and improvement in technical equipment and image quality has led to a significant reduction in perinatal mortality and neurological morbidity. This complication can occur not only in MCDA pregnancies but also in higher order pregnancies such as triplets with a monochorionic component. Furthermore, this can occur also at “unconventional” gestational ages such as before 18 weeks, i.e. “early TTTS”, or after 26 weeks, i.e. In “late TTTS”. The aim of this multicenter retrospective study was to report on perinatal outcomes of multiple pregnancies complicated by TTTS. Methods: This was a multicenter retrospective cohort study including multiple pregnancies with a monochorionic component managed in 21 participating centers around the world from 2007 onwards. The project analyzed data on monochorionic triplet pregnancies and twin complicated by “unconventional” TTTS. Data on maternal age, mode of conception, diagnosis of major fetal structural anomalies or aneuploidy, gestational age (GA) at diagnosis of anoma-lies, twin-to-twin transfusion syndrome (TTTS), twin anemia – polycythemia sequence (TAPS), twin reversed arterial perfusion (TRAP) sequence and or selective fetal growth restriction (sFGR) were retrieved from patient records. Data on antenatal interventions were collected, including data on selective fetal reduction (three to two or three to one for triplets), laser surgery and any other active fetal intervention (including amniodrainage). Data on perinatal outcome were collected, including numbers of livebirth, intrauterine demise, neonatal death, perinatal deathand termination of fetus or pregnancy (TOP). Neonatal data such as GA at birth, birth weight, admission to neonatal intensive care unit and neonatal morbidity were also collected. Perinatal outcomes were assessed according to whether the pregnancy was managed expectantly or underwent fetal intervention. Results and expected results: In our cohort of MCTA triplet pregnancies (n=153 after excluding early miscarriages, TOP and loss to follow-up), the majority (90%) were managed expectantly. The incidence of fetal abnormalities and TRAP was 13.7% and 5.2%, respectively. The most common antenatal complication related to chorionicity was TTTS, which complicated just over a quarter (27.6%) of the pregnancies, followed by sFGR (16.4%), while TAPS (both spontaneous and post-laser) occurred in only 3.3%; no antenatal complication was recorded in 49.3% of pregnancies. Survival was largely associated with the development of these complications: 85.1%, 100% and 47.6% of pregnancies had at least one surviving newborn in those without antenatal complications, complicated by sFGR, or complicated by TTTS, respectively. The overall rates of preterm birth < 28 weeks and <32 weeks’ gestation were 14.5% and 49.2%, respectively. For “unconventional” TTTS, we aim to assess the fetal and perinatal outcomes of twin pregnancies complicated by TTTS and neonatal morbidity. Conclusion: Monochorionicity-related complications can impact adversely perinatal outcome in multiple pregnancies creating a challenge with regard to counseling, surveillance and management.
Perinatal outcomes of monochorionic multiple pregnancies complicated by twin-to-twin transfusion syndrome.
27-set-2024
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11380/1361807
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