1,721,011 research outputs found
Laser therapy and serial amnioreduction as treatment for twin-twin transfusion syndrome: a metaanalysis and review of literature
No full textOBJECTIVE:
The objective of the study was to review current controversy on laser therapy (LT) vs serial amnioreduction (SA) performed for twin-twin transfusion syndrome (TTTS).
STUDY DESIGN:
A search in PubMed from 1997-2007 was performed. Inclusion criteria were diamniotic monochorionic pregnancy, TTTS diagnosed with standard parameters, and peri- and neonatal outcomes well defined. Triplets and investigations on other topics of TTTS rather than perinatal outcomes were excluded. A metaanalysis was performed by fixed-effect model (heterogeneity <25%).
RESULTS:
Ten articles provided 611 cases of TTTS (LT: 70%; SA: 30%) and included 4 studies comparing the 2 treatments (395 cases: LT, 58%; SA, 42%). Fetuses undergoing LT were more likely to survive than fetuses undergoing SA (overall survival rate: P < .0001; odds ratio [OR], 2.04; 95% confidence interval [CI], 1.52-2.76; neonatal death: P < .0001; OR, 0.24; 95% CI, 0.15-0.40; neurologic morbidity: P < .0001; OR, 0.20; 95% CI, 0.12-0.33).
CONCLUSION:
This metaanalysis shows that LT is associated with better outcomes than SA and proposes new topics for future research
Umbilical cord occlusion for selective feticide in complicated monochorionic twins: a systematic review of literature
No full textComparison of donor and recipient outcomes following laser therapy performed for twin-twin transfusion syndrome: a meta-analysis and review of literature
No full textMaternal morbidity following a trial of labor after cesarean section vs elective repeat cesarean delivery: a systematic review with metaanalysis
No full text
Survival Outcomes of Twin-Twin Transfusion Syndrome Stage I: A Systematic Review of Literature.
No full textObjective To review literature about treatment of twin-twin transfusion syndrome (TTTS) stage I.Materials A search in PubMed, EMBASE, Medline, and reference lists was performed. Inclusion criteria were TTTS diagnosed with standard criteria and classified with Quintero staging and survival rates (SR) stratified for stage and first-choice treatment. Outcomes were SR and progression to advanced stages. Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines were followed.Results Seven articles pooled 262 twin sets treated with amnioreduction (16%), conservative management (22%), and laser therapy (62%). The overall SR was 77% after amnioreduction, 86% in the conservative management group, and 85% in the laser therapy group. Progression rate occurred in 30%, 15%, and 0%, respectively. Outcomes were similar between laser therapy as first- versus second-choice treatment. Because most studies were observational and not comparative, a meta-analysis was not performed.Conclusion Conservative management of TTTS stage I is a reasonable option until randomized clinical trials are presented
Neonatal outcomes of assisted and naturally conceived twins: systematic review and meta-analysis.
No full textOBJECTIVE: To review the neonatal outcomes of assisted reproductive technique (ART) vs. naturally conceived (NC) twins.
METHODS: A search in PubMed, Medline, EMBASE, and Cochrane library was performed (January 2000-September 2010). Articles reporting outcomes of ART vs. NC twins were classified in controlled and non-controlled studies. A sub-group was limited to unlike sex twins (UST). The MOOSE guidelines were followed. A randomized model was generated if inter-studies heterogeneity was >25%. Inter-group comparison was significant if P<0.05.
RESULTS: Thirteen articles were reviewed. In non-controlled studies, outcomes were equal between groups, except for cesarean section rates (ART: 71.8%; NC: 49.6%; P<0.0001; OR: 2.34; 95% CI: 1.55-3.54). Similar results were obtained in controlled studies, except for higher rates of preterm delivery in ART (55%) than in NC (53%) twins (P=0.03; OR: 1.30; 95% CI: 1.03-1.65). UST differed with regard to preterm delivery (ART: 58.6%; NC: 49.5%; P<0.0001; OR: 1.51; 95% CI: 1.25-1.83), and perinatal death (ART: 3.6%; NC: 1.8%; P<0.0001; OR: 1.95; 95% CI: 1.41-2.71). Birth weight differed between groups.
CONCLUSION: ART twins carry increased risk of adverse outcomes. UST are at higher risk of perinatal death, although further studies are needed to assess whether chorionicity impacts on neonatal outcomes after ART
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