Pregnancy Outcomes of Previable and PROM following Laser Photocoagulation for Twin-Twin Transfusion Syndrome

The present study describes the pregnancy outcomes of patients who experienced pre-viable and peri-viable pre-labor rupture of membranes (PROM) after treating twin–twin transfusion syndrome.

It conducted a retrospective cohort study of patients with pregnancies complicated by twin–twin transfusion syndrome and treated with fetoscopic laser photocoagulation at a single fetal center and subsequently experienced PROM from April 2010 to June 2019. It looked for infant survival and latency from PROM to delivery. The study grouped the patients with gestational age at PROM (before 26 weeks of gestation and 26 weeks or later) and; stratified the group with PROM before 26 weeks of gestation by gestational age at PROM for further description of outcomes.

The study observed-

• Development of PROM in two-hundred fifty of 653 patients (38%), 81 before 26 weeks of gestation and 169 after 26 weeks of gestation. 
• In the setting of PROM before 26 weeks of gestation, the rate of survival of both twins to neonatal intensive care unit (NICU) discharge was 46.3%, contrasting 76.9% in the setting of PROM at 26 weeks of gestation or later; the survival rate of at least one twin was 61.2% and 98.5%, respectively. 
• PROM was experienced by fourteen, 22, and 45 patients at 16–19 6/7, 20–22 6/7, and 23–25 6/7 weeks of gestation, respectively. 
• Survival of both twins and at least one twin to NICU discharge was 25.0%, 47.4%, 52.8% (for two), and 33.3%, 47.4%, and 77.8% (for at least one), respectively, among the described groups. 
• Latency longer than 48 hours in fifty-seven of the 81 patients with PROM before 26 weeks of gestation. 
• Improvement in overall survival (69.6% vs. 53.7%, respectively) when latency lasted longer than 48 hours in the setting of PROM before 26 weeks of gestation.
• With latency >48 hours and PROM at 16–19 6/7, 20–22 6/7, and 23–25 6/7 weeks of gestation, survival of both twins to NICU discharge was 60.0%, 61.5%, and 60.7%, respectively, and survival of at least one twin was 80.0%, 61.5%, and 85.7%, respectively.

This study shows that earlier gestational age at PROM after laser photocoagulation links with longer latency but lower survival rates. When PROM occurs before 26 weeks of gestation and latency exceeds 48 hours, neonatal survival rates are improved markedly.

Forde B, Fresch R, Masters H, et al. Comparison of Pregnancy Outcomes of Previable and Periviable Rupture of Membranes After Laser Photocoagulation for Twin–Twin Transfusion Syndrome. Obstetrics & Gynecology. 2022;140(6):p 965-973. DOI: 10.1097/AOG.0000000000004970