Abstract：
Fetoscopic laser photocoagulation (FLP) is a well-established treatment for twin-twin transfusion syndrome (TTTS) between 16 and 26 weeks\' gestation. High-quality evidence and guidelines regarding the optimal clinical management of very early (prior to 16 weeks), early (between 16 and 18 weeks) and late (after 26 weeks) TTTS are lacking. The aim of this study was to construct a structured expert-based clinical consensus for the management of early and late TTTS.
A Delphi procedure was conducted among an international panel of experts. Participants were chosen based on their clinical expertise, affiliation and relevant publications. A four-round Delphi survey was conducted using an online platform and responses were collected anonymously. In the first round, a core group of experts was asked to answer open-ended questions regarding the indications, timing and modes of treatment for early and late TTTS. In the second and third rounds, participants were asked to grade each statement on a Likert scale (1, completely disagree; 5, completely agree) and to add any suggestions or modifications. At the end of each round, the median score for each statement was calculated. Statements with a median grade of 5 without suggestions for change were accepted as the consensus. Statements with a median grade of 3 or less were excluded from the Delphi process. Statements with a median grade of 4 were modified according to suggestions and reconsidered in the next round. In the last round, participants were asked to agree or disagree with the statements, and those with more than 70% agreement without suggestions for change were considered the consensus.
A total of 122 experts met the inclusion criteria and were invited to participate, of whom 53 (43.4%) agreed to take part in the study. Of those, 75.5% completed all four rounds. A consensus on the optimal management of early and late TTTS was obtained. FLP can be offered as early as 15 weeks\' gestation for selected cases, and can be considered up to 28 weeks. Between 16 and 18 weeks, management should be tailored according to Doppler findings.
A consensus-based treatment protocol for early and late TTTS was agreed upon by a panel of experts. This protocol should be modified at the discretion of the operator, according to their experience and the specific demands of each case. This should advance the quality of future studies, guide clinical practice and improve patient care. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
A Delphi procedure was conducted among an international panel of experts. Participants were chosen based on their clinical expertise, affiliation and relevant publications. A four-round Delphi survey was conducted using an online platform and responses were collected anonymously. In the first round, a core group of experts was asked to answer open-ended questions regarding the indications, timing and modes of treatment for early and late TTTS. In the second and third rounds, participants were asked to grade each statement on a Likert scale (1, completely disagree; 5, completely agree) and to add any suggestions or modifications. At the end of each round, the median score for each statement was calculated. Statements with a median grade of 5 without suggestions for change were accepted as the consensus. Statements with a median grade of 3 or less were excluded from the Delphi process. Statements with a median grade of 4 were modified according to suggestions and reconsidered in the next round. In the last round, participants were asked to agree or disagree with the statements, and those with more than 70% agreement without suggestions for change were considered the consensus.
A total of 122 experts met the inclusion criteria and were invited to participate, of whom 53 (43.4%) agreed to take part in the study. Of those, 75.5% completed all four rounds. A consensus on the optimal management of early and late TTTS was obtained. FLP can be offered as early as 15 weeks\' gestation for selected cases, and can be considered up to 28 weeks. Between 16 and 18 weeks, management should be tailored according to Doppler findings.
A consensus-based treatment protocol for early and late TTTS was agreed upon by a panel of experts. This protocol should be modified at the discretion of the operator, according to their experience and the specific demands of each case. This should advance the quality of future studies, guide clinical practice and improve patient care. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
摘要：
目的：胎儿镜下激光光凝（FLP）是妊娠16至26周双胎输血综合征（TTTS）的一种行之有效的治疗方法。目前缺乏关于早期（16周之前和16至18周之间）和晚期（26周后）TTTS的最佳临床管理的有力科学证据和统一指南。这项研究的目的是建立一个基于专家的结构化临床共识，以管理早期和晚期TTTS。
方法：一个国际专家小组进行了Delphi程序，以就临床管理达成共识。参与者是根据他们的临床专业知识选择的，从属关系，和相关出版物。启动了四轮Delphi调查。问卷是使用SurveyMonkey发送的，一个在线调查平台，回复是匿名收集的。在第一轮中，一个核心专家组被要求回答关于适应症的开放式问题，早期和晚期TTTS的治疗时机和模式。在接下来的两轮中，参与者被要求在Likert量表(1-5)上对每个陈述进行评分,并添加任何建议或修改.在每一轮结束时，计算每个语句的中位数得分.中位数为5级而没有更改建议的陈述被接受为共识。中位数低于四级的陈述被认为是非共识，并从Delphi中排除。根据建议修改了中位数为四级的陈述，并在下一轮中重新考虑。在最后一轮，参与者被要求同意或不同意的声明，超过70％的同意而没有更改建议的声明被认为是共识。
结果：共有122名学者临床医生符合入选标准并被邀请参加。53人同意参加这项研究。其中,75.4%完成了所有四轮比赛。经过四轮，就早期和晚期TTTS的最佳管理达成了共识。对于选定的病例，可以最早在妊娠15周时提供FLP。在妊娠16到18周之间，应根据多普勒严重程度调整管理。FLP可以被认为是长达28周的妊娠。
结论：Delphi方法允许构建普遍同意的早期和晚期TTTS治疗方案。然而，该协议可以由运营商自行决定修改，和他们的经验，并根据每个案例的具体情况量身定制。这应该提高未来研究的质量，指导临床实践,改善病人护理。本文受版权保护。保留所有权利。
方法：一个国际专家小组进行了Delphi程序，以就临床管理达成共识。参与者是根据他们的临床专业知识选择的，从属关系，和相关出版物。启动了四轮Delphi调查。问卷是使用SurveyMonkey发送的，一个在线调查平台，回复是匿名收集的。在第一轮中，一个核心专家组被要求回答关于适应症的开放式问题，早期和晚期TTTS的治疗时机和模式。在接下来的两轮中，参与者被要求在Likert量表(1-5)上对每个陈述进行评分,并添加任何建议或修改.在每一轮结束时，计算每个语句的中位数得分.中位数为5级而没有更改建议的陈述被接受为共识。中位数低于四级的陈述被认为是非共识，并从Delphi中排除。根据建议修改了中位数为四级的陈述，并在下一轮中重新考虑。在最后一轮，参与者被要求同意或不同意的声明，超过70％的同意而没有更改建议的声明被认为是共识。
结果：共有122名学者临床医生符合入选标准并被邀请参加。53人同意参加这项研究。其中,75.4%完成了所有四轮比赛。经过四轮，就早期和晚期TTTS的最佳管理达成了共识。对于选定的病例，可以最早在妊娠15周时提供FLP。在妊娠16到18周之间，应根据多普勒严重程度调整管理。FLP可以被认为是长达28周的妊娠。
结论：Delphi方法允许构建普遍同意的早期和晚期TTTS治疗方案。然而，该协议可以由运营商自行决定修改，和他们的经验，并根据每个案例的具体情况量身定制。这应该提高未来研究的质量，指导临床实践,改善病人护理。本文受版权保护。保留所有权利。
