{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T22:39:15Z","timestamp":1790635155193,"version":"4.1.0"},"reference-count":25,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2017,5,4]],"date-time":"2017-05-04T00:00:00Z","timestamp":1493856000000},"content-version":"vor","delay-in-days":3,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2017,5]]},"abstract":"ABSTRACT<\/jats:title>Objective<\/jats:title>Preterm delivery after fetoscopic laser surgery (FLS<\/jats:styled-content>) for twin\u2013twin transfusion syndrome (TTTS<\/jats:styled-content>) is a major complication. The causative factors leading to preterm delivery continue to be elusive and a better understanding of the risk factors could reduce complications. The objective of this study was to determine the etiology of preterm delivery after FLS<\/jats:styled-content> for TTTS<\/jats:styled-content> and its associated risk factors.<\/jats:p><\/jats:sec>Methods<\/jats:title>This was a secondary analysis of a prospective study of 203 patients with TTTS<\/jats:styled-content> who underwent FLS<\/jats:styled-content> at a single center between September 2011 and December 2014. Preoperative, operative, postoperative, delivery and neonatal data were reviewed. Preterm delivery was categorized according to etiology into three groups: spontaneous (SPT<\/jats:styled-content>), indicated (IND<\/jats:styled-content>) and elective (ELC<\/jats:styled-content>). Comparisons between groups were performed by ANOVA<\/jats:styled-content>. Kaplan\u2013Meier survival analysis was performed to compare the procedure\u2010to\u2010delivery interval between groups. To identify risk factors for preterm delivery, logistic regression, with calculation of relative risks (RR<\/jats:styled-content>), was performed, with P<\/jats:italic>\u2009<\u20090.05 considered statistically significant.<\/jats:p><\/jats:sec>Results<\/jats:title>Mean gestational age at time of FLS<\/jats:styled-content> was 20.6\u2009\u00b1\u20092.4\u2009weeks and mean gestational age at delivery was 30.9\u2009\u00b1\u20094.7\u2009weeks. Iatrogenic preterm prelabor rupture of membranes (iPPROM<\/jats:styled-content>) occurred in 39% of cases. SPT<\/jats:styled-content> preterm delivery occurred in 97 (48%) patients, IND<\/jats:styled-content> preterm delivery in 65 (32%) and ELC<\/jats:styled-content> preterm delivery in 41 (20%). In the IND<\/jats:styled-content> group, 30 (46%) patients delivered for fetal indications, 31 (48%) for maternal indications and four (6%) for combined fetal and maternal indications. The overall chorioamnionitis rate was 6.4%; of these, nine (9%) were in the SPT<\/jats:styled-content> group and four (6%) were in the IND<\/jats:styled-content> group, with no case occurring in the ELC<\/jats:styled-content> group. There was a significant difference in procedure\u2010to\u2010delivery interval between groups (P<\/jats:italic>\u2009<\u20090.0001). Using variables from the ELC<\/jats:styled-content> group as a baseline, significant risk factors for SPT<\/jats:styled-content> preterm delivery were iPPROM<\/jats:styled-content> (RR<\/jats:styled-content>, 16.2 (95% CI<\/jats:styled-content>, 4.5\u201357.7)), preoperative cervical length (RR<\/jats:styled-content>, 0.96 (95% CI<\/jats:styled-content>, 0.92\u20130.998)) and number of anastomoses (RR<\/jats:styled-content>, 1.14 (95% CI<\/jats:styled-content>, 1.02\u20131.27)). Significant risk factors for IND<\/jats:styled-content> preterm delivery were iPPROM<\/jats:styled-content> (RR<\/jats:styled-content>, 9.6 (95% CI<\/jats:styled-content>, 2.6\u201335.0)) and number of ablated anastomoses (RR<\/jats:styled-content>, 1.13 (95% CI<\/jats:styled-content>, 1.02\u20131.30)).<\/jats:p><\/jats:sec>Conclusion<\/jats:title>iPPROM<\/jats:styled-content> and an increased number of ablated placental anastomoses were associated independently with SPT<\/jats:styled-content> and IND<\/jats:styled-content> preterm deliveries. A shorter preoperative cervical length was associated with SPT<\/jats:styled-content> preterm delivery. Strategies to prevent iPPROM<\/jats:styled-content> and for management of cervical length shortening are needed urgently in these pregnancies. Copyright \u00a9 2016 ISUOG. Published by John Wiley & Sons Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.15972","type":"journal-article","created":{"date-parts":[[2016,5,25]],"date-time":"2016-05-25T08:13:00Z","timestamp":1464163980000},"page":"612-616","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":41,"title":["Preterm delivery after fetoscopic laser surgery for twin\u2013twin transfusion syndrome: etiology and risk factors"],"prefix":"10.1002","volume":"49","author":[{"given":"A.","family":"Malshe","sequence":"first","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Sciences UTHealth Medical School Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Snowise","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Sciences UTHealth Medical School Houston TX USA"},{"name":"The Fetal Center Children's Memorial Hermann Hospital Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. K.","family":"Mann","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Sciences UTHealth Medical School Houston TX USA"},{"name":"The Fetal Center Children's Memorial Hermann Hospital Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Boring","sequence":"additional","affiliation":[{"name":"The Fetal Center Children's Memorial Hermann Hospital Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Sciences UTHealth Medical School Houston TX USA"},{"name":"The Fetal Center Children's Memorial Hermann Hospital Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. 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