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Am J Perinatol. 2018 Jul;35(8):801-808. doi: 10.1055/s-0037-1620268. Epub 2018 Jan 10.

Risks of Preterm Premature Rupture of Membranes and Preterm Birth Post Fetoscopy Based on Location of Trocar Insertion Site.

Author information

1
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California, Keck School of Medicine, Pasadena, California.
2
Childbirth Research Associates, North Hollywood, California.
3
Florida International University, Herbert Wertheim School of Medicine, Miami, Florida.

Abstract

OBJECTIVE:

The objective of this study was to assess whether the location of the trocar insertion site for laser treatment of twin-twin transfusion syndrome was associated with preterm-premature rupture of membranes (PPROM) and preterm birth (PTB).

STUDY DESIGN:

In this study trocar location was documented in the operating room. Lower uterine segment (LUS) location was defined as any insertion <10 cm vertically from the pubic symphysis. Lateral location was defined as ≥5 cm horizontally from the midline. Patient characteristics were tested against three outcomes: PPROM ≤ 21 days postoperative, PTB < 28 weeks, and PTB < 32 weeks. For each outcome, multiple logistic models were fitted to examine the effect of trocar location, controlling for potential risk factors.

RESULTS:

A total of 743 patients were studied. Patients with LUS location were twice as likely as those with a more superior location to have PPROM ≤ 21 days (OR = 2.33, 1.12-4.83, p = 0.0236). Patients with both a LUS and Lateral location were over six times more likely to have PPROM ≤ 21 days (OR = 6.66, 2.36-18.78, p = 0.0003). Trocar insertion site was not associated with PTB.

CONCLUSION:

We found that trocar insertion in the LUS, particularly the lateral LUS, was associated with an increased risk of PPROM.

PMID:
29320800
DOI:
10.1055/s-0037-1620268
[Indexed for MEDLINE]

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