Perinatal outcomes of twin pregnancies complicated by late twin?twin transfusion syndrome: A systematic review and meta?analysis

Introduction Untreated twin-to-twin transfusion syndrome (TTTS) is associated with a high risk of perinatal mortality and morbidity. Laser surgery recommended before 26 weeks gestation. However, the optimal management in case late TTTS (occurring after gestation) yet to be established. Material methods We conducted systematic review meta-analysis evaluate outcomes monochorionic-diamniotic twin pregnancies complicated by according different options (expectant, laser therapy, amnioreduction, or delivery). The primary outcome was mortality, including single double intrauterine, neonatal, death. Secondary were composite morbidity, neuromorbidity, respiratory distress syndrome, admission neonatal intensive care unit, intact survival (ie, free from neurological complications), preterm birth <32 Outcomes reviewed reported for overall population twins disease status donor recipient separately). Random-effect meta-analyses proportions used analyze data. Results Nine studies 796 affected included. No randomized controlled trials available inclusion. occurred at ?26 gestation 8.7% (95% CI 6.9%-10.9%; 67/769) cases reporting all gestations. Intrauterine death 17.7% 4.9%-36.2%) managed expectantly, 5.3% 0.9%-12.9%) treated laser, 0% 0%-9%) amnioreduction. Neonatal 42.5% 17.5%-69.7%) 2.8% 0.3%-7.7%) 20.2% 6%-40%) Only one study (10 cases) data on immediate delivery diagnosis no deaths. Perinatal incidence 55.7% 31.4%-78.6%) 5.6% 0.5%-15.3%) those Intact 44.4%, 96.4%, 78% fetuses respectively. Conclusions Evidence regarding morbidity managements very low quality. Therefore further high-quality research this field needed elucidate these pregnancies.