{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T21:28:29Z","timestamp":1774906109667,"version":"3.50.1"},"reference-count":31,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2021,8,3]],"date-time":"2021-08-03T00:00:00Z","timestamp":1627948800000},"content-version":"vor","delay-in-days":2,"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":[[2021,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate the association of laser photocoagulation of placental anastomoses (LPA) prior to 18\u2009weeks' gestation (early LPA) with very preterm delivery and neonatal survival in pregnancies with twin\u2013twin transfusion syndrome (TTTS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective cohort study of monochorionic diamniotic twin pregnancies with TTTS undergoing LPA between 2002 and 2018 at two institutions. The rates of delivery &lt;\u200928, &lt;\u200930 and &lt;\u200932\u2009weeks' gestation, preterm prelabor rupture of membranes (PPROM) and 30\u2010day survival of one or both infants were compared between pregnancies undergoing early LPA and those undergoing LPA \u2265\u200918\u2009weeks' gestation. Regression analysis was performed to determine the association of early LPA with very preterm delivery and 30\u2010day survival, adjusted for Quintero stage, study phase, selective fetal growth restriction, gestational age at delivery, maternal age \u2265\u200935\u2009years, body mass index &gt;\u200935\u2009kg\/m<jats:sup>2<\/jats:sup>, placental location, use of Seldinger method to place the operative trocar, size of the trocar, participating center, use of Solomon technique, cerclage and PPROM. Survival analysis using the Cox proportional hazard model was applied to examine the LPA\u2010to\u2010delivery interval according to the timing of surgery, adjusted for confounding variables.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 414 TTTS pregnancies were included in the study, of which 68 (16.4%) underwent early LPA. In the total cohort, the incidence of delivery at &lt;\u200928, &lt;\u200930 and &lt;\u200932\u2009weeks' gestation was 22.7%, 39.6% and 53.4%, respectively. Survival of both twins and survival of at least one twin at 30\u2009days were 67.5% and 90.8%, respectively. No significant difference was noted between pregnancies that underwent early LPA and those that had LPA \u2265\u200918\u2009weeks in the rate of delivery &lt;\u200928\u2009weeks (19.1% <jats:italic>vs<\/jats:italic> 23.4%; <jats:italic>P<\/jats:italic>\u2009=\u20090.4), &lt;\u200930\u2009weeks (38.2% <jats:italic>vs<\/jats:italic> 39.9%; <jats:italic>P<\/jats:italic>\u2009=\u20090.8) and &lt;\u200932\u2009weeks (44.1% <jats:italic>vs<\/jats:italic> 55.2%; <jats:italic>P<\/jats:italic>\u2009=\u20090.1) and PPROM (29.0% <jats:italic>vs<\/jats:italic> 24.1%; <jats:italic>P<\/jats:italic>\u2009=\u20090.4), or in the incidence of double\u2010twin survival (63.9% <jats:italic>vs<\/jats:italic> 68.1%; <jats:italic>P<\/jats:italic>\u2009=\u20090.5) and survival of at least one infant (91.8% <jats:italic>vs<\/jats:italic> 90.6%; <jats:italic>P<\/jats:italic>\u2009=\u20090.7) at 30\u2009days. Early LPA was not associated with very preterm delivery or neonatal survival in the regression analyses. Early LPA was associated with a longer LPA\u2010to\u2010delivery interval compared with LPA performed \u2265\u200918\u2009weeks (median, 106.9\u2009days (range, 2\u2013164\u2009days) <jats:italic>vs<\/jats:italic> median, 69.3\u2009days (range, 0\u2013146\u2009days); <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) when adjusted for confounding variables (hazard ratio, 2.56 (95%\u2009CI, 1.76\u20133.73); <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Laser surgery before 18\u2009weeks is not associated with an increased rate of very preterm delivery and PPROM or with reduced neonatal survival when compared with LPA after 18\u2009weeks. \u00a9 2020 International Society of Ultrasound in Obstetrics and Gynecology<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.22190","type":"journal-article","created":{"date-parts":[[2020,8,31]],"date-time":"2020-08-31T04:24:46Z","timestamp":1598847886000},"page":"207-213","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Early laser surgery is not associated with very preterm delivery or reduced neonatal survival in <scp>TTTS<\/scp>"],"prefix":"10.1002","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9830-2212","authenticated-orcid":false,"given":"J.","family":"Espinoza","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Baylor College of Medicine  Houston TX USA"},{"name":"Texas Children's Hospital Pavilion for Women  Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7887-5737","authenticated-orcid":false,"given":"M. A.","family":"Belfort","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Baylor College of Medicine  Houston TX USA"},{"name":"Texas Children's Hospital Pavilion for Women  Houston TX USA"},{"name":"Michael E. DeBakey Department of Surgery Baylor College of Medicine  Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A. A.","family":"Shamshirsaz","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Baylor College of Medicine  Houston TX USA"},{"name":"Texas Children's Hospital Pavilion for Women  Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1924-7965","authenticated-orcid":false,"given":"A. A.","family":"Nassr","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Baylor College of Medicine  Houston TX USA"},{"name":"Texas Children's Hospital Pavilion for Women  Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Sanz Cortes","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Baylor College of Medicine  Houston TX USA"},{"name":"Texas Children's Hospital Pavilion for Women  Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R.","family":"Donepudi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Baylor College of Medicine  Houston TX USA"},{"name":"Texas Children's Hospital Pavilion for Women  Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A. F.","family":"Espinoza","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Baylor College of Medicine  Houston TX USA"},{"name":"Michael E. DeBakey Department of Surgery Baylor College of Medicine  Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T. 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