Research: Perinatal outcomes of iatrogenic chorioamniotic separation following fetoscopic surgeries: a systematic review and meta-analysis

Ultrasound Obstet Gynecol

. 2021 Jan 11. doi: 10.1002/uog.23588. Online ahead of print.

Perinatal outcomes of iatrogenic chorioamniotic separation following fetoscopic surgeries: a systematic review and meta-analysis

A A Nassr 1K Hessami 2S A Shazly 3 4N Meshinchi 1R Corroenne 5J Espinoza 1R Donepudi 1M Sanz Cortes 1M A Belfort 1A A Shamshirsaz 1Affiliations expand

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Aim: This systematic review and meta-analysis aims to compare the perinatal outcomes of pregnancies with and without iatrogenic chorioamniotic separation (iCAS) after fetoscopic interventions.

Methods: We performed a search in PubMed, Embase, Scopus, Web of Science and Google Scholar from inception up to December 2020 for studies evaluating perinatal variables among pregnancies developing iCAS after fetal interventions for twin to twin transfusion syndrome (TTTS), open neural tube defects (ONTD), congenital diaphragmatic hernia and other fetoscopic guided interventions. Afterward, the random-effects model was used to pool the mean differences (MDs) or odds ratios (OR) and the corresponding 95% confidence intervals (CIs). Primary outcome was neonatal survival. Secondary outcomes included gestational age (GA) at the intervention and delivery, intervention to delivery interval, risks of preterm premature rupture of membranes (PPROM) and preterm delivery.

Results: The electronic search identified 348 records, of which seven studies (6 on TTTS and 1 on ONTD fetoscopic repair) assessed perinatal outcome of iCAS pregnancies after fetoscopic interventions. Given that only one study reported on fetoscopic ONTD repair, this meta-analysis was limited to TTTS pregnancies. Six studies for TTTS (total of 1881 pregnancies) were included for final analysis. Development of iCAS after fetoscopic laser photocoagulation (FLP) for TTTS was associated with significantly lower GA at the time of intervention (weeks) (MD -1.07, 95% CI -1.89, -0.24, P 0.01), lower GA at delivery (weeks) (MD -1.74, 95% CI: -3.13, -0.34, P 0.01) and lower neonatal survival (OR 0.41, 95% CI: 0.24, 0.70, p 0.001). In addition, iCAS in the TTTS group significantly increased risks for PPROM < 34 weeks (OR 3.98; 95% CI: 1.76, 9.03, P < 0.001) and preterm delivery < 32 weeks (OR 1.80; 95% CI: 1.16, 2.80, P 0.008; I2 48%) in this population.

Conclusion: Iatrogenic chorioamniotic separation is a commonly observed complication after FLP for TTTS. In the TTTS patients, iCAS tends to develop more with earlier GA at intervention and is associated with earlier GA at delivery, higher risk of PPROM, preterm delivery before 32 weeks’ gestation and lower neonatal survival. Given the limitations of this meta-analysis and lack of literature reporting on other types of fetoscopic interventions, the presented findings should be interpreted with caution and should not be generalized to fetoscopic procedures used to treat other fetal conditions. This article is protected by copyright. All rights reserved.

Keywords: TTTS; chorioamniotic membrane; endoscopic fetal suregry; perinatal outcome; separation.

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