PMID- 27399997
OWN - NLM
STAT- MEDLINE
DCOM- 20170608
LR  - 20180112
IS  - 1873-233X (Electronic)
IS  - 0029-7844 (Linking)
VI  - 128
IP  - 2
DP  - 2016 Aug
TI  - Histologic Chorioamnionitis and Funisitis After Laser Surgery for Twin-Twin
      Transfusion Syndrome.
PG  - 304-12
LID - 10.1097/AOG.0000000000001469 [doi]
AB  - OBJECTIVE: To estimate the incidence of histologic chorioamnionitis and funisitis
      after fetoscopic laser surgery for the management of twin-twin transfusion
      syndrome. METHODS: A case-control study was performed at the Leiden University
      Medical Center from 2013 to 2014. All patients with twin-twin transfusion
      syndrome managed with laser surgery during the study period were included and
      compared with a control group of all monochorionic twins not treated with laser
      surgery. We excluded patients with fetal demise or higher order pregnancies.
      Placentas were reviewed for the presence and degree of chorioamnionitis and
      presence or absence of fetal inflammatory response. The primary outcome was the
      incidence of histologic chorioamnionitis and funisitis after laser surgery. Odds 
      ratios (ORs) and 95% confidence intervals (CIs) for primary outcomes were
      calculated. A P value of <.05 was considered as statistical significance.
      RESULTS: Sixty-two patients treated with laser surgery were included in the study
      group and compared with 64 patients in the control group. The incidence of
      histologic chorioamnionitis was 13% (8/62) in the laser group compared with 5%
      (3/64) in the control group (OR 3.0, 95% CI 0.8-11.9, P=.12). Funisitis occurred 
      in 8% (10/124) in the laser group compared with 0% in the control group (OR 11.1,
      95% CI 1.3-96.9, P=.03). Histologic chorioamnionitis with or without funisitis
      after laser surgery was associated with a shorter laser-to-delivery interval
      (median 6.6 [range 3.4-14.1] compared with 13.6 [4.4-20.1] weeks, P<.01) and
      lower gestational age at birth (median 28.1 [range 23.1-32.6] compared with 32.7 
      [24.4-37.0] weeks, P<.01). CONCLUSION: These findings suggest that laser surgery 
      for twin-twin transfusion syndrome is associated with an increased risk of
      funisitis.
FAU - Zhao, Depeng
AU  - Zhao D
AD  - Division of Neonatology, Department of Pediatrics, the Department of Pathology,
      the Division of Fetal Medicine, Department of Obstetrics, and the Department of
      Medical Statistics, Leiden University Medical Center, Leiden, the Netherlands;
      and the Department of Pathology, Women and Infants Hospital, Providence, Rhode
      Island.
FAU - Cohen, Danielle
AU  - Cohen D
FAU - Middeldorp, Johanna M
AU  - Middeldorp JM
FAU - van Zwet, Erik W
AU  - van Zwet EW
FAU - De Paepe, Monique E
AU  - De Paepe ME
FAU - Oepkes, Dick
AU  - Oepkes D
FAU - Lopriore, Enrico
AU  - Lopriore E
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Obstet Gynecol
JT  - Obstetrics and gynecology
JID - 0401101
SB  - AIM
SB  - IM
MH  - Case-Control Studies
MH  - Chorioamnionitis/*epidemiology/etiology/pathology
MH  - Female
MH  - Fetofetal Transfusion/*surgery
MH  - Fetoscopy/adverse effects
MH  - Gestational Age
MH  - Humans
MH  - Incidence
MH  - Laser Therapy/*adverse effects
MH  - Odds Ratio
MH  - Postoperative Complications/*epidemiology/etiology/pathology
MH  - Pregnancy
MH  - Pregnancy, Twin
MH  - Premature Birth/epidemiology/etiology
EDAT- 2016/07/12 06:00
MHDA- 2017/06/09 06:00
CRDT- 2016/07/12 06:00
PHST- 2016/07/12 06:00 [entrez]
PHST- 2016/07/12 06:00 [pubmed]
PHST- 2017/06/09 06:00 [medline]
AID - 10.1097/AOG.0000000000001469 [doi]
PST - ppublish
SO  - Obstet Gynecol. 2016 Aug;128(2):304-12. doi: 10.1097/AOG.0000000000001469.