Abstract：
To ascertain maternal and perinatal outcomes of monochorionic twin pregnancies complicated by twin-twin transfusion syndrome (TTTS) treated with the Solomon technique compared with selective fetoscopic laser photocoagulation (SFLP) of placental anastomoses.
MEDLINE, EMBASE and The Cochrane Library were searched to identify relevant studies. The outcomes observed were perinatal loss and survival, preterm prelabor rupture of membranes (PPROM), preterm birth (PTB), gestational age (GA) at delivery, interval between laser treatment and delivery, maternal bleeding, septostomy or chorioamniotic separation, placental abruption, twin anemia-polycythemia sequence (TAPS), recurrence of TTTS, neonatal morbidity and neurological morbidity. Random-effects head-to-head meta-analyses were used to analyze the data. Pooled odds ratios (OR) and mean differences (MD) and their 95% CIs were calculated.
Nine studies were included in the systematic review. There was generally no difference in the main maternal and pregnancy characteristics between pregnancies treated using the Solomon technique and those treated using SFLP of placental anastomoses. The risks of fetal loss (pooled OR, 0.69 (95% CI, 0.50-0.95); P = 0.023), neonatal death (pooled OR, 0.37 (95% CI, 0.16-0.84); P = 0.018) and perinatal loss (pooled OR, 0.56 (95% CI, 0.38-0.83); P = 0.004) were significantly lower in pregnancies treated using the Solomon technique than in those treated with SFLP. Likewise, pregnancies treated using the Solomon technique had a significantly higher chance of survival of at least one twin (pooled OR, 2.31 (95% CI, 1.03-5.19); P = 0.004) and double survival (pooled OR, 2.18 (95% CI, 1.29-3.70); P = 0.001). There was no difference in the risk of PPROM (P = 0.603), PPROM within 10 days from laser surgery (P = 0.982), PTB (P = 0.207), maternal bleeding (P = 0.219), septostomy or chorioamniotic separation (P = 0.224) or chorioamnionitis (P = 0.135) between the two groups, while the risk of placental abruption was higher in pregnancies treated using the Solomon technique (pooled OR, 2.90 (95% CI, 1.55-5.44); P = 0.001). In the Solomon technique group, pregnancies delivered at a significantly earlier GA than did those treated with SFLP (pooled MD, -0.625 weeks (95% CI, -0.90 to -0.35 weeks); P < 0.001), while there was no difference in the interval between laser treatment and delivery (P = 0.589). The rate of recurrence of TTTS was significantly lower in pregnancies undergoing the Solomon technique (pooled OR, 0.43 (95% CI, 0.22-0.81); P < 0.001), while there was no difference in the risk of TAPS between the two groups (P = 0.792). Finally, there was no difference in the overall risk of neonatal morbidity (P = 0.382) or neurological morbidity (P = 0.247) between the two groups.
Monochorionic twin pregnancies complicated by TTTS undergoing laser treatment using the Solomon technique had a significantly higher survival rate and lower recurrence rate of TTTS but were associated with an increased risk of placental abruption and earlier GA at delivery compared to those treated with SFLP. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
MEDLINE, EMBASE and The Cochrane Library were searched to identify relevant studies. The outcomes observed were perinatal loss and survival, preterm prelabor rupture of membranes (PPROM), preterm birth (PTB), gestational age (GA) at delivery, interval between laser treatment and delivery, maternal bleeding, septostomy or chorioamniotic separation, placental abruption, twin anemia-polycythemia sequence (TAPS), recurrence of TTTS, neonatal morbidity and neurological morbidity. Random-effects head-to-head meta-analyses were used to analyze the data. Pooled odds ratios (OR) and mean differences (MD) and their 95% CIs were calculated.
Nine studies were included in the systematic review. There was generally no difference in the main maternal and pregnancy characteristics between pregnancies treated using the Solomon technique and those treated using SFLP of placental anastomoses. The risks of fetal loss (pooled OR, 0.69 (95% CI, 0.50-0.95); P = 0.023), neonatal death (pooled OR, 0.37 (95% CI, 0.16-0.84); P = 0.018) and perinatal loss (pooled OR, 0.56 (95% CI, 0.38-0.83); P = 0.004) were significantly lower in pregnancies treated using the Solomon technique than in those treated with SFLP. Likewise, pregnancies treated using the Solomon technique had a significantly higher chance of survival of at least one twin (pooled OR, 2.31 (95% CI, 1.03-5.19); P = 0.004) and double survival (pooled OR, 2.18 (95% CI, 1.29-3.70); P = 0.001). There was no difference in the risk of PPROM (P = 0.603), PPROM within 10 days from laser surgery (P = 0.982), PTB (P = 0.207), maternal bleeding (P = 0.219), septostomy or chorioamniotic separation (P = 0.224) or chorioamnionitis (P = 0.135) between the two groups, while the risk of placental abruption was higher in pregnancies treated using the Solomon technique (pooled OR, 2.90 (95% CI, 1.55-5.44); P = 0.001). In the Solomon technique group, pregnancies delivered at a significantly earlier GA than did those treated with SFLP (pooled MD, -0.625 weeks (95% CI, -0.90 to -0.35 weeks); P < 0.001), while there was no difference in the interval between laser treatment and delivery (P = 0.589). The rate of recurrence of TTTS was significantly lower in pregnancies undergoing the Solomon technique (pooled OR, 0.43 (95% CI, 0.22-0.81); P < 0.001), while there was no difference in the risk of TAPS between the two groups (P = 0.792). Finally, there was no difference in the overall risk of neonatal morbidity (P = 0.382) or neurological morbidity (P = 0.247) between the two groups.
Monochorionic twin pregnancies complicated by TTTS undergoing laser treatment using the Solomon technique had a significantly higher survival rate and lower recurrence rate of TTTS but were associated with an increased risk of placental abruption and earlier GA at delivery compared to those treated with SFLP. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
摘要：
为了确定使用Solomon技术治疗的单绒毛膜双胎妊娠并发双胎输血综合征（TTTS）的产妇和围产期结局，与胎盘吻合术的选择性胎儿镜激光光凝（SFLP）相比。
MEDLINE,搜索EMBASE和Cochrane图书馆以确定相关研究。观察到的结局是围产期损失和生存率，早产胎膜破裂（PPROM），早产（PTB），分娩时的胎龄（GA），激光治疗和分娩之间的间隔，产妇出血,隔膜造口术或绒毛膜羊膜分离术，胎盘早剥,双胎贫血-红细胞增多症序列（TAPS），TTTS复发,新生儿发病率和神经系统发病率。随机效应头对头荟萃分析用于分析数据。计算汇总优势比（OR）和平均差（MD）及其95％CI。
系统评价中纳入了9项研究。使用所罗门技术治疗的妊娠与使用胎盘吻合术的SFLP治疗的妊娠之间的主要母体和妊娠特征通常没有差异。胎儿丧失的风险(汇总OR，0.69（95%CI，0.50-0.95）；P=0.023），新生儿死亡（汇集或，0.37(95%CI，0.16-0.84)；P=0.018)和围产期损失(合并OR，使用所罗门技术治疗的妊娠患者的0.56（95％CI，0.38-0.83）；P=0.004）显着低于使用SFLP治疗的妊娠患者。同样，使用所罗门技术治疗的怀孕至少有一个双胞胎的存活机会显着提高（合并OR，2.31(95%CI，1.03-5.19)；P=0.004)和双生存率(合并OR，2.18（95%CI，1.29-3.70）；P=0.001）。PPROM的风险无差异(P=0.603),激光手术后10天内PPROM（P=0.982），PTB(P=0.207),产妇出血（P=0.219），两组间进行间隔造口术或绒毛膜羊膜分离(P=0.224)或绒毛膜羊膜炎(P=0.135),而使用Solomon技术治疗的妊娠中胎盘早剥的风险较高（合并OR，2.90（95%CI，1.55-5.44）；P=0.001）。在所罗门技术组中，与使用SFLP治疗的妊娠相比，在GA明显更早分娩的妊娠（合并MD，-0.625周（95％CI，-0.90至-0.35周）；P<0.001），激光治疗和分娩之间的间隔没有差异（P=0.589）。在接受所罗门技术的妊娠中，TTTS的复发率显着降低（合并OR，0.43（95%CI，0.22-0.81）；P<0.001），而TAPS的风险在两组之间没有差异(P=0.792)。最后,两组新生儿发病率(P=0.382)和神经系统发病率(P=0.247)的总体风险无差异.
与接受SFLP治疗的患者相比，在使用Solomon技术进行激光治疗的TTTS并发的单绒毛膜双胎妊娠具有显著更高的生存率和更低的TTTS复发率，但与胎盘早剥和分娩时早期GA的风险增加相关。©2022国际妇产科超声学会。
MEDLINE,搜索EMBASE和Cochrane图书馆以确定相关研究。观察到的结局是围产期损失和生存率，早产胎膜破裂（PPROM），早产（PTB），分娩时的胎龄（GA），激光治疗和分娩之间的间隔，产妇出血,隔膜造口术或绒毛膜羊膜分离术，胎盘早剥,双胎贫血-红细胞增多症序列（TAPS），TTTS复发,新生儿发病率和神经系统发病率。随机效应头对头荟萃分析用于分析数据。计算汇总优势比（OR）和平均差（MD）及其95％CI。
系统评价中纳入了9项研究。使用所罗门技术治疗的妊娠与使用胎盘吻合术的SFLP治疗的妊娠之间的主要母体和妊娠特征通常没有差异。胎儿丧失的风险(汇总OR，0.69（95%CI，0.50-0.95）；P=0.023），新生儿死亡（汇集或，0.37(95%CI，0.16-0.84)；P=0.018)和围产期损失(合并OR，使用所罗门技术治疗的妊娠患者的0.56（95％CI，0.38-0.83）；P=0.004）显着低于使用SFLP治疗的妊娠患者。同样，使用所罗门技术治疗的怀孕至少有一个双胞胎的存活机会显着提高（合并OR，2.31(95%CI，1.03-5.19)；P=0.004)和双生存率(合并OR，2.18（95%CI，1.29-3.70）；P=0.001）。PPROM的风险无差异(P=0.603),激光手术后10天内PPROM（P=0.982），PTB(P=0.207),产妇出血（P=0.219），两组间进行间隔造口术或绒毛膜羊膜分离(P=0.224)或绒毛膜羊膜炎(P=0.135),而使用Solomon技术治疗的妊娠中胎盘早剥的风险较高（合并OR，2.90（95%CI，1.55-5.44）；P=0.001）。在所罗门技术组中，与使用SFLP治疗的妊娠相比，在GA明显更早分娩的妊娠（合并MD，-0.625周（95％CI，-0.90至-0.35周）；P<0.001），激光治疗和分娩之间的间隔没有差异（P=0.589）。在接受所罗门技术的妊娠中，TTTS的复发率显着降低（合并OR，0.43（95%CI，0.22-0.81）；P<0.001），而TAPS的风险在两组之间没有差异(P=0.792)。最后,两组新生儿发病率(P=0.382)和神经系统发病率(P=0.247)的总体风险无差异.
与接受SFLP治疗的患者相比，在使用Solomon技术进行激光治疗的TTTS并发的单绒毛膜双胎妊娠具有显著更高的生存率和更低的TTTS复发率，但与胎盘早剥和分娩时早期GA的风险增加相关。©2022国际妇产科超声学会。
