{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T12:57:22Z","timestamp":1793105842663,"version":"4.5.0"},"reference-count":38,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2021,1,12]],"date-time":"2021-01-12T00:00:00Z","timestamp":1610409600000},"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":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Untreated twin\u2010to\u2010twin transfusion syndrome (TTTS) is associated with a high risk of perinatal mortality and morbidity. Laser surgery is recommended before 26\u00a0weeks of gestation. However, the optimal management in case of late TTTS (occurring after 26\u00a0weeks of gestation) is yet to be established.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>We conducted a systematic review and meta\u2010analysis to evaluate the outcomes of monochorionic\u2010diamniotic twin pregnancies complicated by late TTTS according to different management options (expectant, laser therapy, amnioreduction, or delivery). The primary outcome was mortality, including single and double intrauterine, neonatal, and perinatal death. Secondary outcomes were composite morbidity, neuromorbidity, respiratory distress syndrome, admission to neonatal intensive care unit, intact survival (ie, free from neurological complications), and preterm birth before &lt;32\u00a0weeks of gestation. Outcomes were reviewed according to the management and reported for the overall population of twins and disease status (ie, donor and recipient separately). Random\u2010effect meta\u2010analyses of proportions were used to analyze the data.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Nine studies including 796 twin pregnancies affected by TTTS were included. No randomized controlled trials were available for inclusion. TTTS occurred at \u226526\u00a0weeks of gestation in 8.7% (95% CI 6.9%\u201010.9%; 67\/769) of cases reporting TTTS at all gestations. Intrauterine death occurred in 17.7% (95% CI 4.9%\u201036.2%) of pregnancies managed expectantly, 5.3% (95% CI 0.9%\u201012.9%) of pregnancies treated with laser, and 0% (95% CI 0%\u20109%) after amnioreduction. Neonatal death occurred in 42.5% (95% CI 17.5%\u201069.7%) of pregnancies managed expectantly, in 2.8% (95% CI 0.3%\u20107.7%) of cases treated with laser, and in 20.2% (95% CI 6%\u201040%) after amnioreduction. Only one study (10 cases) reported data on immediate delivery after diagnosis with no perinatal deaths. Perinatal death incidence was 55.7% (95% CI 31.4%\u201078.6%) in twin pregnancies managed expectantly, 5.6% (95% CI 0.5%\u201015.3%) in those treated with laser, and 20.2% (95% CI 6%\u201040%) in those after amnioreduction. Intact survival was reported in 44.4%, 96.4%, and 78% of fetuses managed expectantly, with laser or amnioreduction, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Evidence regarding perinatal mortality and morbidity in twin pregnancies complicated by late TTTS according to the different managements was of very low quality. Therefore further high\u2010quality research in this field is needed to elucidate the optimal management of these pregnancies.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.14066","type":"journal-article","created":{"date-parts":[[2020,12,18]],"date-time":"2020-12-18T19:16:19Z","timestamp":1608318979000},"page":"832-842","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Perinatal outcomes of twin pregnancies complicated by late twin\u2010twin transfusion syndrome: A systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"100","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7380-0576","authenticated-orcid":false,"given":"Filomena Giulia","family":"Sileo","sequence":"first","affiliation":[{"name":"Fetal Medicine Unit St George\u2019s Hospital St George\u2019s University of London London UK"},{"name":"Department of Biomedical, Metabolic and Neural Sciences International Doctorate School in Clinical and Experimental Medicine University of Modena and Reggio Emilia Modena Italy"},{"name":"Unit of Obstetrics and Gynecology Azienda Unit\u00e0 Sanitaria Locale \u2010 IRCCS Reggio Emilia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"D\u2019antonio","sequence":"additional","affiliation":[{"name":"Prenatal Medicine Unit, Obstetrics and Gynecology Unit University \"G. d'Annunzio\" of Chieti Chieti Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Can","family":"Benlioglu","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit St George\u2019s Hospital St George\u2019s University of London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2393-7501","authenticated-orcid":false,"given":"Amar","family":"Bhide","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit St George\u2019s Hospital St George\u2019s University of London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asma","family":"Khalil","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit St George\u2019s Hospital St George\u2019s University of London London UK"},{"name":"Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute St George's University of London London UK"},{"name":"Twins Trust Centre for Research and Clinical Excellence St George\u2019s Hospital London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,1,12]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.15821"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2012.09.025"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.semperi.2012.02.006"},{"key":"e_1_2_9_5_1","first-page":"CD002073","article-title":"Interventions for the treatment of twin\u2013twin transfusion syndrome","volume":"1","author":"Roberts D","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa032597"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.17520"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1017\/thg.2016.26"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.22143"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0301-2115(00)00440-1"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1080\/jmf.16.2.95.101"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2001.117188"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2007.09.043"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2019.08.058"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2007.01337.x"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1159\/000330369"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2012.11.027"},{"key":"e_1_2_9_18_1","unstructured":"Prisma statement.http:\/\/www.prisma\u2010statement.org\/[accessed 10 June 2020]."},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.283.15.2008"},{"key":"e_1_2_9_20_1","unstructured":"WellsGA SheaB O\u2019ConnellD et al.The Newcastle\u2010Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta\u2010analyses.http:\/\/www.ohri.ca\/programs\/clinical_epidemiology\/oxford.asp. 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