Abstract：
BACKGROUND: Pseudoamniotic band sequence (PABS) is a rare iatrogenic consequence of invasive fetal interventions, most commonly fetoscopic laser surgery (FLS) in monochorionic multiple pregnancies complicated by twin-to-twin transfusion syndrome (TTTS).
OBJECTIVE: The aim of this study was to investigate prenatal risk factors and perinatal outcomes for pregnancies involving PABS after FLS for TTTS and compare outcomes between those undergoing fetoscopic band release versus not.
METHODS: We conducted a systematic search of PubMed, Scopus, and Web of Science on studies reporting PABS following FLS for TTTS. A meta-analysis of pooled proportions was conducted.
RESULTS: There were 16 studies covering 47 pregnancies complicated by PABS following FLS, mostly case series and case reports. The incidence of PABS was 2%, with the recipient twin affected in 94% of the cases. Pregnancies complicated by PABS were associated with inter-twin septostomy in 32% and chorioamniotic separation (CAS) in 90%. The mean gestational age (GA) at FLS and delivery were 17.7 and 30.9 weeks, respectively. Preterm premature rupture of membranes (PPROM) happened in 62% of pregnancies. The risk of preterm birth (PTB) <34 weeks, <32 weeks, and <28 weeks were 94%, 67%, and 31%, respectively. There were 41% fetal demises and 64% live births among the affected fetuses. Results of fetoscopic band release versus not were comparable, including GA at delivery, PPROM, and PTB at 32 weeks. It was noted that the likelihood of PTB by 28 weeks (67% vs. 23%) and fetal death (50% vs. 39%) were higher in the band release group. It was similar between groups in terms of postnatal amputation.
CONCLUSIONS: PABS causes amputations or fetal death in more than one-third of cases. Pregnancies with an inter-twin septostomy, CAS, advanced TTTS staging, and early GA are more likely to experience PABS. In addition, more than a third of FLS-treated TTTS resulted in PTB and PPROM. PABS cases with prenatal band release showed higher rates of PTB and fetal death, but the data were from small, heterogeneous studies.
OBJECTIVE: The aim of this study was to investigate prenatal risk factors and perinatal outcomes for pregnancies involving PABS after FLS for TTTS and compare outcomes between those undergoing fetoscopic band release versus not.
METHODS: We conducted a systematic search of PubMed, Scopus, and Web of Science on studies reporting PABS following FLS for TTTS. A meta-analysis of pooled proportions was conducted.
RESULTS: There were 16 studies covering 47 pregnancies complicated by PABS following FLS, mostly case series and case reports. The incidence of PABS was 2%, with the recipient twin affected in 94% of the cases. Pregnancies complicated by PABS were associated with inter-twin septostomy in 32% and chorioamniotic separation (CAS) in 90%. The mean gestational age (GA) at FLS and delivery were 17.7 and 30.9 weeks, respectively. Preterm premature rupture of membranes (PPROM) happened in 62% of pregnancies. The risk of preterm birth (PTB) <34 weeks, <32 weeks, and <28 weeks were 94%, 67%, and 31%, respectively. There were 41% fetal demises and 64% live births among the affected fetuses. Results of fetoscopic band release versus not were comparable, including GA at delivery, PPROM, and PTB at 32 weeks. It was noted that the likelihood of PTB by 28 weeks (67% vs. 23%) and fetal death (50% vs. 39%) were higher in the band release group. It was similar between groups in terms of postnatal amputation.
CONCLUSIONS: PABS causes amputations or fetal death in more than one-third of cases. Pregnancies with an inter-twin septostomy, CAS, advanced TTTS staging, and early GA are more likely to experience PABS. In addition, more than a third of FLS-treated TTTS resulted in PTB and PPROM. PABS cases with prenatal band release showed higher rates of PTB and fetal death, but the data were from small, heterogeneous studies.
摘要：
背景：调查胎儿镜激光手术（FLS）治疗双胎对双胎输血综合征（TTTS）后涉及假羊膜带序列（PABS）的妊娠的产前危险因素和围产期结局，并比较那些接受胎儿镜引带释放和不是。
方法：我们对PubMed进行了系统搜索，Scopus,和WebofScience关于在TTTSFLS之后报告PABS的研究。进行了汇总比例的荟萃分析。
结果：有16项研究涵盖了FLS后并发PABS的47例妊娠，主要是病例系列和病例报告。PABS的发生率为2%，受助双胞胎在94%的病例中受到影响。PABS并发的妊娠与32％的双胎间隔造口术和90％的绒毛膜羊膜分离（CAS）相关。FLS和分娩时的平均胎龄（GA）分别为17.7和30.9周。早产胎膜早破（PPROM）发生在62％的妊娠中。早产风险（PTB）<34周，<32周,<28周为94%，67%,31%,分别。受影响的胎儿中有41％的胎儿死亡和64％的活产。胎儿镜带释放的结果与不具有可比性，包括交付时的GA，PPROM,和PTB在32周。注意到，在条带释放组中，28周时发生PTB的可能性（67％对23％）和胎儿死亡的可能性（50％对39％）更高。在产后截肢方面，组间相似。
结论：在超过三分之一的病例中，PABS会导致截肢或胎儿死亡。有双生子间隔造口术的怀孕,CAS,高级TTTS分期，早期GA更有可能经历PABS。此外,超过三分之一的FLS治疗的TTTS导致PTB和PPROM。产前释放带的PABS病例显示PTB和胎儿死亡率较高，但是数据很小，异质性研究。
方法：我们对PubMed进行了系统搜索，Scopus,和WebofScience关于在TTTSFLS之后报告PABS的研究。进行了汇总比例的荟萃分析。
结果：有16项研究涵盖了FLS后并发PABS的47例妊娠，主要是病例系列和病例报告。PABS的发生率为2%，受助双胞胎在94%的病例中受到影响。PABS并发的妊娠与32％的双胎间隔造口术和90％的绒毛膜羊膜分离（CAS）相关。FLS和分娩时的平均胎龄（GA）分别为17.7和30.9周。早产胎膜早破（PPROM）发生在62％的妊娠中。早产风险（PTB）<34周，<32周,<28周为94%，67%,31%,分别。受影响的胎儿中有41％的胎儿死亡和64％的活产。胎儿镜带释放的结果与不具有可比性，包括交付时的GA，PPROM,和PTB在32周。注意到，在条带释放组中，28周时发生PTB的可能性（67％对23％）和胎儿死亡的可能性（50％对39％）更高。在产后截肢方面，组间相似。
结论：在超过三分之一的病例中，PABS会导致截肢或胎儿死亡。有双生子间隔造口术的怀孕,CAS,高级TTTS分期，早期GA更有可能经历PABS。此外,超过三分之一的FLS治疗的TTTS导致PTB和PPROM。产前释放带的PABS病例显示PTB和胎儿死亡率较高，但是数据很小，异质性研究。
