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CME Credit Offered
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Poster Session 3

(905) Risk Factors for PPROM Following Laser Surgery in Twin-to-Twin Transfusion Syndrome

Friday, January 31, 2025
10:30 AM – 12:30 PM  

    Submitting Author and Presenting Author(s)

  • Sami Backley, MD

    Clinical Fellow PGY 9
    Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
    Houston, Texas, United States

    • Coauthor(s)

  • Eric P. Bergh, MD

    Associate Professor
    Nemours Children's Health
    Wilmington, Delaware, United States

  • Felicia V. LeMoine, MD (she/her/hers)

    Fetal Intervention Fellow
    Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
    Houston, Texas, United States

  • Neha Agarwal, MBBS, MD

    Post doctoral Research Fellow
    Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, UTHealth McGovern Medical School, Houston, TX, USA
    Houston, Texas, United States

  • GV

    Gustavo Vilchez, MD, MSCR

    UTHealth Houston
    Houston, Texas, United States

  • AS

    Ashley Salazar, DNP

    Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UT Health Houston
    Houston, Texas, United States

  • Edgar A. Hernandez-Andrade, MD, PhD (he/him/his)

    Professor
    McGovern Medical School at UTHealth Houston
    Houston, Texas, United States

  • Anthony Johnson, DO

    Professor
    McGovern Medical School University of Texas Health Science Center at Houston (UThealth)
    Houston, Texas, United States

  • Ramesha Papanna, MD, MPH

    Professor
    McGovern Medical School at UTHealth Houston
    Houston, Texas, United States

  • Jimmy Espinoza, MD, MSc

    Professor
    Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
    Houston, Texas, United States

Objective: Preterm prelabor rupture of membranes (PPROM) is the most frequent complication of in-utero surgery. The intraoperative use of distention media, such as lactated Ringer’s, is thought to be caustic to the amniotic membrane. We sought to identify risk factors of PPROM following fetoscopic laser surgery (FLS) for twin-twin transfusion syndrome (TTTS).

Study Design: This single-center prospective cohort study included monochorionic-diamniotic twin pregnancies who underwent FLS between 2011 and 2024 for management of TTTS. PPROM was defined as PROM < 34 weeks’ gestation. Pregnancies with missing delivery or neonatal outcomes were excluded. Maternal characteristics and perioperative factors were compared using comparative statistics. Multiple logistic regression was performed to evaluate the relationship between PPROM and the following factors: gestational age (GA) at FLS, amnioinfusion, and other confounders. Cox proportional hazard modeling was performed to evaluate factors influencing the procedure-to-delivery interval (days).

Results: PPROM occurred in 292 (39%) of 748 eligible pregnancies. Clinical characteristics are displayed in Table 1. GA at delivery was earlier and smaller amnioreduction volumes were seen in pregnancies with PPROM compared pregnancies without PPROM (Table 1). GA at FLS (adjusted odds ratio [aOR] 0.85, 95% confidence interval [CI] 0.77-0.94), pre-operative cervical length (aOR 0.98, 95% CI 0.96-0.99), placental abruption (aOR 1.94, 95% CI 1.01-3.72), collagen plug placement (aOR 2.17, 95% CI 1.18, 3.98) and chorioamnion membrane separation (CAS) (aOR 5.42, 95% CI 2.54-11.56) were associated with the diagnosis of PPROM. PPROM, CAS, cervical length prior to FLS, placental abruption, and GA at FLS independently influenced procedure-to-delivery interval (Figure 1).

Conclusion:

PPROM remains a major complication of FLS resulting in an earlier GA at delivery. CAS is the most important risk factor for PPROM after FLS surgery while amnioinfusion of ≥1 L is not a risk factor for PPROM following FLS for the management of TTTS.