{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T05:38:14Z","timestamp":1791437894732,"version":"4.3.3"},"reference-count":35,"publisher":"Cambridge University Press (CUP)","issue":"3","license":[{"start":{"date-parts":[[2016,5,3]],"date-time":"2016-05-03T00:00:00Z","timestamp":1462233600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Twin Res Hum Genet"],"published-print":{"date-parts":[[2016,6]]},"abstract":"<jats:p><jats:italic>Objectives:<\/jats:italic>The natural history of stage 1 Twin-to-twin transfusion syndrome (TTTS) remains unclear and its optimal management is yet to be established. The main aims of this meta-analysis were to quantify the incidence of progression in stage 1 TTTS and to ascertain survival in these pregnancies.<\/jats:p><jats:p><jats:italic>Methods:<\/jats:italic>MEDLINE, EMBASE, and The Cochrane Library were searched. Reference lists within each article were hand-searched for additional reports. The outcomes included incidence of progression and survival in stage 1 TTTS. Randomized controlled trials, cohort and case-control studies were included. Case reports, studies including three or fewer cases of stage 1 TTTS, and editorials were excluded. Proportion meta-analysis was used for analysis (Registration number: CRD42016036190).<\/jats:p><jats:p><jats:italic>Results:<\/jats:italic>The search yielded 3,085 citations; 18 studies were included in the review (172 pregnancies to assess progression and 433 pregnancies to assess the survival). The pooled incidence of progression in stage 1 TTTS was 27% [95% CI 16\u201339%]. The pooled overall survival, double survival and at least one survival in the pregnancies managed expectantly were 79% [95% CI 62\u201392%], 70% [95% CI 54\u201384%] and 87% [95% CI 69\u201398%], respectively. In those undergoing amnioreduction, the corresponding figures were 77% [95% CI 68\u201385%], 67% [95% CI 57\u201376%] and 86% [95% CI 76\u201394%], respectively. The survival rates were 68% [95% CI 54\u201381%], 54% [95% CI 36\u201372%], and 81% [95% CI 69\u201390%], when laser surgery was performed.<\/jats:p><jats:p><jats:italic>Conclusions:<\/jats:italic>The optimal initial management of stage 1 TTTS remains in equipoise. The ongoing randomized trial comparing immediate laser surgery versus conservative management should provide a definitive answer.<\/jats:p>","DOI":"10.1017\/thg.2016.33","type":"journal-article","created":{"date-parts":[[2016,5,3]],"date-time":"2016-05-03T10:46:49Z","timestamp":1462272409000},"page":"207-216","source":"Crossref","is-referenced-by-count":51,"title":["Evolution of Stage 1 Twin-to-Twin Transfusion Syndrome (TTTS): Systematic Review and Meta-Analysis"],"prefix":"10.1017","volume":"19","author":[{"given":"Asma","family":"Khalil","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Cooper","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosemary","family":"Townsend","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basky","family":"Thilaganathan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2016,5,3]]},"reference":[{"key":"S1832427416000335_ref035","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2009.05.034"},{"key":"S1832427416000335_ref027","first-page":"5","article-title":"Survival outcomes of twin\u2013twin transfusion syndrome stage I: A systematic review of literature","volume":"30","author":"Rossi","year":"2013","journal-title":"American Journal of Obstetrics and Gynecology"},{"key":"S1832427416000335_ref015","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2014.03.003"},{"key":"S1832427416000335_ref012","unstructured":"Higgins J. 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