{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:57:24Z","timestamp":1786978644108,"version":"build-2736575974"},"reference-count":32,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2020,3,2]],"date-time":"2020-03-02T00:00:00Z","timestamp":1583107200000},"content-version":"vor","delay-in-days":1,"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":[[2020,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To explore the outcome of monochorionic monoamniotic (MCMA) twin pregnancies affected by twin\u2010to\u2010twin transfusion syndrome (TTTS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>MEDLINE and EMBASE databases were searched for studies reporting the outcome of MCMA twin pregnancies complicated by TTTS. The primary outcome was intrauterine death (IUD); secondary outcomes were miscarriage, single IUD, double IUD, neonatal death (NND), perinatal death (PND), survival of at least one twin, survival of both twins and preterm birth (PTB) before 32\u2009weeks' gestation. Outcomes were assessed in MCMA twins affected by TTTS not undergoing intervention and in those treated with amniodrainage, laser therapy or cord occlusion. Subgroup analysis was performed including cases diagnosed before 24\u2009weeks. Random\u2010effects meta\u2010analysis of proportions was used to analyze the data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Fifteen cohort studies, including 888 MCMA twin pregnancies, of which 44 were affected by TTTS, were included in the review. There was no randomized trial comparing the different management options in MCMA twin pregnancies complicated by TTTS. In cases not undergoing intervention, miscarriage occurred in 11.0% of fetuses, while the incidence of IUD, NND and PND was 25.2%, 12.2% and 31.2%, respectively. PTB complicated 50.5% of these pregnancies. In cases treated by laser surgery, the incidence of miscarriage, IUD, NND and PND was 19.6%, 27.4%, 7.4% and 35.9%, respectively, and the incidence of PTB before 32\u2009weeks' gestation was 64.9%. In cases treated with amniodrainage, the incidence of IUD, NND and PND was 31.3%, 13.5% and 45.7% respectively, and PTB complicated 76.2% of these pregnancies. Analysis of cases undergoing cord occlusion was affected by the very small number of included cases. Miscarriage occurred in 19.2%, while there was no case of IUD or NND of the surviving twin. PTB before 32\u2009weeks occurred in 50.0% of these cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>MCMA twin pregnancies complicated by TTTS are at high risk of perinatal mortality and PTB. Further studies are needed in order to elucidate the optimal type of prenatal treatment in these pregnancies. Copyright \u00a9 2019 ISUOG. Published by John Wiley &amp; Sons Ltd.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/uog.21889","type":"journal-article","created":{"date-parts":[[2019,10,9]],"date-time":"2019-10-09T01:58:52Z","timestamp":1570586332000},"page":"310-317","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":46,"title":["Outcome of twin\u2010to\u2010twin transfusion syndrome in monochorionic monoamniotic twin pregnancy: systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7225-2763","authenticated-orcid":false,"given":"D.","family":"Murgano","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Chieti  Chieti Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2802-7670","authenticated-orcid":false,"given":"A.","family":"Khalil","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit St George's University Hospitals NHS Foundation Trust, University of London, London, UK; and Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7793-714X","authenticated-orcid":false,"given":"F.","family":"Prefumo","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Spedali Riunit  Brescia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T. Van","family":"Mieghem","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Mount Sinai Hospital and University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5525-4353","authenticated-orcid":false,"given":"G.","family":"Rizzo","sequence":"additional","affiliation":[{"name":"Division of Maternal and Fetal Medicine, Ospedale Cristo Re University of Rome Tor Vergata  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. D.","family":"Heyborne","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Denver Health and Hospital Authority, Denver, CO, USA; Department of Obstetrics and Gynecology University of Colorado Denver  Aurora CO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Melchiorre","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology \u2018Spirito Santo\u2019 Hospital  Pescara Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Peeters","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Leiden University Medical Center  Leiden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9884-5778","authenticated-orcid":false,"given":"L.","family":"Lewi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University Hospitals of KU Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6353-9383","authenticated-orcid":false,"given":"A.","family":"Familiari","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Fondazione IRCCS, Ca Granda, Ospedale Maggiore Policlinico  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Lopriore","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Neonatology Leiden University Medical Center  Leiden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Oepkes","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Leiden University Medical Center  Leiden The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Murata","sequence":"additional","affiliation":[{"name":"Center for Maternal, Fetal and Neonatal Medicine Fukuoka University Hospital  Fukuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"O.","family":"Anselem","sequence":"additional","affiliation":[{"name":"Maternit\u00e9 Port\u2010Royal, Groupe Hospitalier Cochin\u2010Broca\u2010H\u00f4tel\u2010Dieu Universit\u00e9 Paris Descartes, Assistance Publique\u2010H\u00f4pitaux de Paris (AP\u2010HP)  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Buca","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Chieti  Chieti Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Liberati","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Chieti  Chieti Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Hack","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Gelre Hospitals  Apeldoorn The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Nappi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Department of Medical and Surgical Sciences University of Foggia  Foggia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. 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