{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T22:38:09Z","timestamp":1790635089620,"version":"4.1.0"},"reference-count":62,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T00:00:00Z","timestamp":1638316800000},"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":["BJOG"],"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate the efficacy of long\u2010term indomethacin therapy (LIT) in prolonging pregnancy and reducing spontaneous preterm birth (PTB) in patients undergoing fetoscopic laser surgery (FLS) for the management of twin\u2010to\u2010twin transfusion syndrome (TTTS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective cohort study of prospectively collected data.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Collaborative multicentre study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>Five hundred and fifty\u2010seven consecutive TTTS cases that underwent FLS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Long\u2010term indomethacin therapy was defined as indomethacin use for at least 48\u2009hours. Log\u2010binomial regression was used to estimate the relative risk of PTB in the LIT group compared with a non\u2010LIT group. Cox regression was used to evaluate the association between LIT use and FLS\u2010to\u2010delivery survival.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Gestational age (GA) at delivery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among the 411 pregnancies included, a total of 180 patients (43.8%) received LIT after FLS and 231 patients (56.2%) did not. Median GA at fetal intervention did not differ between groups (20.4\u2009weeks). Median GA at delivery was significantly higher in the LIT group (33.6\u2009weeks) compared with the non\u2010LIT group (31.1\u2009weeks; <jats:italic>P\u2009<\/jats:italic>&lt;\u20090.001). FLS\u2010to\u2010delivery interval was significantly longer in the LIT group (<jats:italic>P\u2009<\/jats:italic>&lt;\u20090.001). The risks of PTB before 34, 32, 28 and 26\u2009weeks of gestation were all significantly lower in the LIT group compared with the non\u2010LIT group (relative risks 0.69, 0.51, 0.37 and 0.18, respectively). The number needed to treat with LIT to prevent one PTB before 32\u2009weeks of gestation was four, and to prevent one PTB before 34\u2009weeks was five.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Long\u2010term indomethacin after FLS for TTTS was found to be associated with prolongation of pregnancy and reduced risk for PTB.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>Long\u2010term indomethacin used after fetoscopic laser surgery for twin\u2010to\u2010twin transfusion syndrome is effective in prolonging pregnancy and reducing the risk for preterm birth; especially extreme preterm birth.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.17017","type":"journal-article","created":{"date-parts":[[2021,11,15]],"date-time":"2021-11-15T15:32:55Z","timestamp":1636990375000},"page":"597-606","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Efficacy of long\u2010term indomethacin therapy in prolonging pregnancy after fetoscopic laser surgery for twin\u2010to\u2010twin transfusion syndrome: a collaborative cohort study"],"prefix":"10.1111","volume":"129","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5611-1231","authenticated-orcid":false,"given":"HJ","family":"Mustafa","sequence":"first","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Sciences University of Maryland School of Medicine Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E","family":"Krispin","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Baylor College of Medicine and Texas Children's Fetal Center Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2995-9181","authenticated-orcid":false,"given":"H","family":"Tadbiri","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Sciences University of Maryland School of Medicine Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9830-2212","authenticated-orcid":false,"given":"J","family":"Espinoza","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Baylor College of Medicine and Texas Children's Fetal Center Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"AA","family":"Shamshirsaz","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Baylor College of Medicine and Texas Children's Fetal Center Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1924-7965","authenticated-orcid":false,"given":"AA","family":"Nassr","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Baylor College of Medicine and Texas Children's Fetal Center Houston TX 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