{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T21:17:18Z","timestamp":1792531038283,"version":"4.5.0"},"reference-count":59,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2020,11,12]],"date-time":"2020-11-12T00:00:00Z","timestamp":1605139200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To report the outcome of pregnancies complicated by twin\u2013twin transfusion syndrome (TTTS) according to Quintero stage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>MEDLINE, EMBASE and CINAHL databases were searched for studies reporting the outcome of pregnancies complicated by TTTS stratified according to Quintero stage (I\u2013V). The primary outcome was fetal survival rate according to Quintero stage. Secondary outcomes were gestational age at birth, preterm birth (PTB) before 34, 32 and 28\u2009weeks' gestation and neonatal morbidity. Outcomes are reported according to the different management options (expectant management, laser therapy or amnioreduction) for pregnancies with Stage\u2010I TTTS. Only cases treated with laser therapy were considered for those with Stages\u2010II\u2013IV TTTS and only cases managed expectantly were considered for those with Stage\u2010V TTTS. Random\u2010effects head\u2010to\u2010head meta\u2010analysis was used to analyze the extracted data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty\u2010six studies (2699 twin pregnancies) were included. Overall, 610 (22.6%) pregnancies were diagnosed with Quintero stage\u2010I TTTS, 692 (25.6%) were Stage II, 1146 (42.5%) were Stage III, 247 (9.2%) were Stage IV and four (0.1%) were Stage V. Survival of at least one twin occurred in 86.9% (95%\u2009CI, 84.0\u201389.7%) (456\/552) of pregnancies with Stage\u2010I, in 85% (95%\u2009CI, 79.1\u201390.1%) (514\/590) of those with Stage\u2010II, in 81.5% (95%\u2009CI, 76.6\u201386.0%) (875\/1040) of those with Stage\u2010III, in 82.8% (95%\u2009CI, 73.6\u201390.4%) (172\/205) of those with Stage\u2010IV and in 54.6% (95%\u2009CI, 24.8\u201382.6%) (5\/9) of those with Stage\u2010V TTTS. The rate of a pregnancy with no survivor was 11.8% (95%\u2009CI, 8.4\u201315.8%) (69\/564) in those with Stage\u2010I, 15.0% (95%\u2009CI, 9.9\u201320.9%) (76\/590) in those with Stage\u2010II, 18.6% (95%\u2009CI, 14.2\u201323.4%) (165\/1040) in those with Stage\u2010III, 17.2% (95%\u2009CI, 9.6\u201326.4%) (33\/205) in those with Stage\u2010IV and in 45.4% (95%\u2009CI, 17.4\u201375.2%) (4\/9) in those with Stage\u2010V TTTS. Gestational age at birth was similar in pregnancies with Stages\u2010I\u2013III TTTS, and gradually decreased in those with Stages\u2010IV and \u2010V TTTS. Overall, the incidence of PTB and neonatal morbidity increased as the severity of TTTS increased, but data on these two outcomes were limited by the small sample size of the included studies. When stratifying the analysis of pregnancies with Stage\u2010I TTTS according to the type of intervention, the rate of fetal survival of at least one twin was 84.9% (95%\u2009CI, 70.4\u201395.1%) (94\/112) in cases managed expectantly, 86.7% (95%\u2009CI, 82.6\u201390.4%) (249\/285) in those undergoing laser therapy and 92.2% (95%\u2009CI, 84.2\u201397.6%) (56\/60) in those after amnioreduction, while the rate of double survival was 67.9% (95%\u2009CI, 57.0\u201377.9%) (73\/108), 69.7% (95%\u2009CI, 61.6\u201377.1%) (203\/285) and 80.8% (95%\u2009CI, 62.0\u201394.2%) (49\/60), respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Overall survival in monochorionic diamniotic pregnancies affected by TTTS is higher for earlier Quintero stages (I and II), but fetal survival rates are moderately high even in those with Stage\u2010III or \u2010IV TTTS when treated with laser therapy. Gestational age at birth was similar in pregnancies with Stages\u2010I\u2013III TTTS, and gradually decreased in those with Stages\u2010IV and \u2010V TTTS treated with laser and expectant management, respectively. In pregnancies affected by Stage\u2010I TTTS, amnioreduction was associated with slightly higher survival compared with laser therapy and expectant management, although these findings may be confirmed only by future head\u2010to\u2010head randomized trials. Copyright \u00a9 2020 ISUOG. Published by John Wiley &amp; Sons Ltd.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/uog.22054","type":"journal-article","created":{"date-parts":[[2020,4,24]],"date-time":"2020-04-24T14:39:11Z","timestamp":1587739151000},"page":"811-820","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":75,"title":["Outcome of twin\u2013twin transfusion syndrome according to Quintero stage of disease: systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6560-3393","authenticated-orcid":false,"given":"D.","family":"Di Mascio","sequence":"first","affiliation":[{"name":"Department of Maternal and Child Health and Urological Sciences Sapienza University of Rome  Rome Italy"},{"name":"Division of Maternal\u2010Fetal Medicine, Department of Obstetrics and Gynecology Sidney Kimmel Medical College of Thomas Jefferson University  Philadelphia PA USA"}],"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"},{"name":"Vascular Biology Research Centre Molecular and Clinical Sciences Research Institute, St George's University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"D'Amico","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Chieti  Chieti Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6880-7407","authenticated-orcid":false,"given":"D.","family":"Buca","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Chieti  Chieti Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Benedetti Panici","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Health and Urological Sciences Sapienza University of Rome  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. E.","family":"Flacco","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences University of Ferrara  Ferrara Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Manzoli","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences University of Ferrara  Ferrara 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":"L.","family":"Nappi","sequence":"additional","affiliation":[{"name":"Fetal Medicine and Cardiology Unit, Department of Obstetrics and Gynecology, Department of Medical and Surgical Sciences University of Foggia  Foggia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6902-6095","authenticated-orcid":false,"given":"V.","family":"Berghella","sequence":"additional","affiliation":[{"name":"Division of Maternal\u2010Fetal Medicine, Department of Obstetrics and Gynecology Sidney Kimmel Medical College of Thomas Jefferson University  Philadelphia PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5178-3354","authenticated-orcid":false,"given":"F.","family":"D'Antonio","sequence":"additional","affiliation":[{"name":"Fetal Medicine and Cardiology Unit, Department of Obstetrics and Gynecology, Department of Medical and Surgical Sciences University of Foggia  Foggia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,11,12]]},"reference":[{"key":"e_1_2_7_2_1","first-page":"146","article-title":"Practice Bulletin No. 169: Multifetal Gestations: Twin, Triplet, and Higher\u2010Order Multifetal Pregnancies","volume":"128","author":"Committee on Practice Bulletins\u00a0\u2013\u00a0Obstetrics; Society for Maternal\u2013Fetal Medicine","year":"2016","journal-title":"Obstet Gynecol"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2012.10.880"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.17348"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.17362"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.18966"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.20100"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.13613"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.21889"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.20357"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.19179"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.12495"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1017\/thg.2016.34"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.jp.7200292"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1017\/thg.2016.33"},{"key":"e_1_2_7_16_1","first-page":"5","article-title":"Survival outcomes of twin\u2013twin transfusion syndrome stage I: a systematic review of literature","volume":"30","author":"Rossi AC","year":"2013","journal-title":"Am J Perinatol"},{"key":"e_1_2_7_17_1","first-page":"480","article-title":"Natural history of twin\u2013twin transfusion syndrome","volume":"46","author":"Berghella V","year":"2001","journal-title":"J Reprod Med"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2007.06.055"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.7713"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1797.2010.01380.x"},{"key":"e_1_2_7_21_1","volume-title":"Systematic reviews: CRD's guidance for undertaking reviews in health care","author":"NHS Centre for Reviews and Dissemination","year":"2009"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2015.09.001"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-151-4-200908180-00135"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i157"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.283.15.2008"},{"key":"e_1_2_7_26_1","unstructured":"Newcastle\u2013Ottawa Scale for assessing the quality of nonrandomised studies in meta\u2010 analyses. Available at:http:\/\/www.ohri.ca\/programs\/clinical_epidemiology\/oxford.asp."},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2014.03.003"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0024384"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0038-1627095"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.5468\/ogs.2018.61.4.461"},{"key":"e_1_2_7_31_1","article-title":"The natural history of twin\u2013twin transfusion syndrome stratified by Quintero stage","volume":"29","author":"Duryea EL","year":"2016","journal-title":"J Matern Fetal Neonatal Med"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tjog.2015.05.006"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.4814"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2016.04.024"},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.15753"},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.1159\/000362385"},{"key":"e_1_2_7_37_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.12492"},{"key":"e_1_2_7_38_1","doi-asserted-by":"publisher","DOI":"10.3109\/14767058.2012.668585"},{"key":"e_1_2_7_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2011.02.001"},{"key":"e_1_2_7_40_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.7612"},{"key":"e_1_2_7_41_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.2430"},{"key":"e_1_2_7_42_1","first-page":"1137","article-title":"Outcome of pregnancies complicated by twin\u2013twin transfusion syndrome in King Chulalongkorn Memorial Hospital","volume":"93","author":"Korpraphong S","year":"2010","journal-title":"J Med Assoc Thai"},{"key":"e_1_2_7_43_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1479-828X.2009.01127.x"},{"key":"e_1_2_7_44_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2010.02680.x"},{"key":"e_1_2_7_45_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1479-828X.2008.00942.x"},{"key":"e_1_2_7_46_1","doi-asserted-by":"publisher","DOI":"10.1590\/S1807-59322009000200005"},{"key":"e_1_2_7_47_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2009.05.034"},{"key":"e_1_2_7_48_1","doi-asserted-by":"publisher","DOI":"10.1159\/000098715"},{"key":"e_1_2_7_49_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.5189"},{"key":"e_1_2_7_50_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.1829"},{"key":"e_1_2_7_51_1","doi-asserted-by":"publisher","DOI":"10.1375\/twin.9.3.438"},{"key":"e_1_2_7_52_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000225945.17022.6b"},{"key":"e_1_2_7_53_1","first-page":"1190","article-title":"Perinatal characteristics and outcomes of pregnancies complicated by twin\u2013twin transfusion syndrome","volume":"101","author":"Duncombe GJ","year":"2003","journal-title":"Obstet Gynecol"},{"key":"e_1_2_7_54_1","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2003.292"},{"key":"e_1_2_7_55_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2015.10.020"},{"key":"e_1_2_7_56_1","first-page":"1","article-title":"Outcome after fetoscopic laser coagulation in twin\u2013twin transfusion syndrome\u00a0\u2013\u00a0is the survival rate of at least one child at 6 months of age dependent on preoperative cervical length and preterm prelabour rupture of fetal membranes?","volume":"10","author":"R\u00fcegg L","year":"2018","journal-title":"J Matern Neonatal Med"},{"key":"e_1_2_7_57_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.15147"},{"key":"e_1_2_7_58_1","doi-asserted-by":"publisher","DOI":"10.1159\/000437053"},{"key":"e_1_2_7_59_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e318231827f"},{"key":"e_1_2_7_60_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2009.05.036"}],"container-title":["Ultrasound in Obstetrics &amp; Gynecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fuog.22054","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.22054","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/uog.22054","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.22054","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,27]],"date-time":"2023-08-27T22:59:34Z","timestamp":1693177174000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/uog.22054"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11,12]]},"references-count":59,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["10.1002\/uog.22054"],"URL":"https:\/\/doi.org\/10.1002\/uog.22054","archive":["Portico"],"relation":{},"ISSN":["0960-7692","1469-0705"],"issn-type":[{"value":"0960-7692","type":"print"},{"value":"1469-0705","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11,12]]},"assertion":[{"value":"2019-11-25","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-04-12","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-11-12","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}