Proximate Cord Insertion in Twin-to-Twin Transfusion Syndrome: Case Series and PRISMA compliant Systematic Review and Meta-analysis

Objective: We aimed to investigate the prevalence and clinical outcomes of twin-to-twin transfusion syndrome (TTTS) with proximate cord insertions. Methods: Retrospective cohort study of TTTS cases managed at single fetal center between 2012 and 2020. Presence of proximate cord insertions defined as a distance of equal or less than four centimeters between placental cord insertions that was recorded based on sonographic and fetoscopic examinations. Clinical outcomes were investigated compared to unmatched cohort and to 1:2 matched controls using pre-operative variables including: Quintero staging, selective fetal growth restriction (sFGR), anterior placenta, pre-operative cervical length (CL), and gestational age (GA) at fetal intervention. Systematic review and meta-analysis were conducted following PRSMA guidelines through searching PubMed, Scopus, CINAHL, and Medline databases from inception until January 2021. Results: The prevalence of proximate cord insertions in monochorionic placentas with TTTS was 2% (5/246). All five cases were managed by fetoscopic laser surgery (FLS). Procedure time was significantly longer (mean: 61.4 minutes in proximate cord vs 37.5 minutes in non-proximate cord, p
Source: Fetal Diagnosis and Therapy - Category: Perinatology & Neonatology Source Type: research