Abstract：
OBJECTIVE: We aimed to perform a systematic review and network meta-analysis to evaluate the preventive strategies for preterm birth in twin-to-twin transfusion syndrome.
METHODS: PubMed, Embase and Cochrane Central were searched from inception to December 2023 with no filters. Additionally, the reference lists of the included studies were manually examined to identify any supplementary studies. We selected randomized controlled trials and cohorts comparing interventions to prevent preterm birth in twin pregnancies complicated by twin-to-twin transfusion syndrome. A random-effects frequentist network meta-analysis was performed using RStudio version 4.3.1. Randomized controlled trials and cohorts were assessed respectively using the Risk of Bias in Non-randomized Studies of interventions tool and Cochrane Collaboration\'s tool for assessing risk of bias in randomized trials.
RESULTS: In this systematic review and meta-analysis, we included eight studies comprising a total of 719 patients. Compared with expectant management, cerclage stood out as the only intervention associated with an increase in the survival of at least one twin (risk ratio 1.12; 95 % confidence interval 1.01-1.23). Our subgroup analysis based on different thresholds for short cervix demonstrated a significant reduction in the risk of preterm birth before 32 weeks with ultrasound-indicated cerclage using a 15 mm criterion (risk ratio 0.65; 95 % confidence interval 0.47-0.92).
CONCLUSIONS: Our study suggests the potential benefit of cerclage as a preventive strategy for preterm birth in pregnancies complicated by twin-to-twin transfusion syndrome. These findings highlight the necessity for further investigation to corroborate our results and address the optimal threshold for ultrasound-indicated cerclage.
METHODS: PubMed, Embase and Cochrane Central were searched from inception to December 2023 with no filters. Additionally, the reference lists of the included studies were manually examined to identify any supplementary studies. We selected randomized controlled trials and cohorts comparing interventions to prevent preterm birth in twin pregnancies complicated by twin-to-twin transfusion syndrome. A random-effects frequentist network meta-analysis was performed using RStudio version 4.3.1. Randomized controlled trials and cohorts were assessed respectively using the Risk of Bias in Non-randomized Studies of interventions tool and Cochrane Collaboration\'s tool for assessing risk of bias in randomized trials.
RESULTS: In this systematic review and meta-analysis, we included eight studies comprising a total of 719 patients. Compared with expectant management, cerclage stood out as the only intervention associated with an increase in the survival of at least one twin (risk ratio 1.12; 95 % confidence interval 1.01-1.23). Our subgroup analysis based on different thresholds for short cervix demonstrated a significant reduction in the risk of preterm birth before 32 weeks with ultrasound-indicated cerclage using a 15 mm criterion (risk ratio 0.65; 95 % confidence interval 0.47-0.92).
CONCLUSIONS: Our study suggests the potential benefit of cerclage as a preventive strategy for preterm birth in pregnancies complicated by twin-to-twin transfusion syndrome. These findings highlight the necessity for further investigation to corroborate our results and address the optimal threshold for ultrasound-indicated cerclage.
摘要：
目的：我们旨在进行系统评价和网络荟萃分析，以评估双胎对双胎输血综合征早产的预防策略。
方法：PubMed，Embase和CochraneCentral从成立到2023年12月进行了搜索，没有过滤器。此外,我们手动检查了纳入研究的参考列表,以确定任何补充研究.我们选择了随机对照试验和队列，比较双胎妊娠并发双胎输血综合征预防早产的干预措施。使用RStudio4.3.1版进行了随机效应频率网络荟萃分析。使用非随机干预研究中的偏倚风险工具和CochraneCollaboration评估随机试验中偏倚风险的工具分别评估随机对照试验和队列。
结果：在本系统综述和荟萃分析中，我们纳入了8项研究,共719例患者.与预期管理相比，环扎术是唯一与至少一个双胞胎生存率增加相关的干预措施(风险比1.12;95%置信区间1.01-1.23).我们基于短宫颈不同阈值的亚组分析显示，使用15mm标准（风险比0.65；95％置信区间0.47-0.92），超声指示的环扎术在32周前可显着降低早产风险。
结论：我们的研究表明，环扎术作为预防妊娠并发双胎对双胎输血综合征的早产的潜在益处。这些发现强调了进一步研究以证实我们的结果并解决超声指示的环扎的最佳阈值的必要性。
方法：PubMed，Embase和CochraneCentral从成立到2023年12月进行了搜索，没有过滤器。此外,我们手动检查了纳入研究的参考列表,以确定任何补充研究.我们选择了随机对照试验和队列，比较双胎妊娠并发双胎输血综合征预防早产的干预措施。使用RStudio4.3.1版进行了随机效应频率网络荟萃分析。使用非随机干预研究中的偏倚风险工具和CochraneCollaboration评估随机试验中偏倚风险的工具分别评估随机对照试验和队列。
结果：在本系统综述和荟萃分析中，我们纳入了8项研究,共719例患者.与预期管理相比，环扎术是唯一与至少一个双胞胎生存率增加相关的干预措施(风险比1.12;95%置信区间1.01-1.23).我们基于短宫颈不同阈值的亚组分析显示，使用15mm标准（风险比0.65；95％置信区间0.47-0.92），超声指示的环扎术在32周前可显着降低早产风险。
结论：我们的研究表明，环扎术作为预防妊娠并发双胎对双胎输血综合征的早产的潜在益处。这些发现强调了进一步研究以证实我们的结果并解决超声指示的环扎的最佳阈值的必要性。
