Risks of Preterm Premature Rupture of Membranes and Preterm Birth Post Fetoscopy Based on Location of Trocar Insertion Site

Ramen H. Chmait; Andrew H. Chon; Lisa M. Korst; Arlyn Llanes; Eftichia V. Kontopoulos; Ruben A. Quintero

doi:10.1055/s-0037-1620268

American Journal of Perinatology, Table of Contents

Am J Perinatol 2018; 35(08): 801-808
DOI: 10.1055/s-0037-1620268

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Risks of Preterm Premature Rupture of Membranes and Preterm Birth Post Fetoscopy Based on Location of Trocar Insertion Site

Ramen H. Chmait

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California, Keck School of Medicine, Pasadena, California

,

Andrew H. Chon

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California, Keck School of Medicine, Pasadena, California

,

Lisa M. Korst

²Childbirth Research Associates, North Hollywood, California

,

Arlyn Llanes

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California, Keck School of Medicine, Pasadena, California

,

Eftichia V. Kontopoulos

³Florida International University, Herbert Wertheim School of Medicine, Miami, Florida

,

Ruben A. Quintero

³Florida International University, Herbert Wertheim School of Medicine, Miami, Florida

› Author Affiliations

Abstract

Objective The objective of this study was to assess whether the location of the trocar insertion site for laser treatment of twin-twin transfusion syndrome was associated with preterm-premature rupture of membranes (PPROM) and preterm birth (PTB).

Study Design In this study trocar location was documented in the operating room. Lower uterine segment (LUS) location was defined as any insertion <10 cm vertically from the pubic symphysis. Lateral location was defined as ≥5 cm horizontally from the midline. Patient characteristics were tested against three outcomes: PPROM ≤ 21 days postoperative, PTB < 28 weeks, and PTB < 32 weeks. For each outcome, multiple logistic models were fitted to examine the effect of trocar location, controlling for potential risk factors.

Results A total of 743 patients were studied. Patients with LUS location were twice as likely as those with a more superior location to have PPROM ≤ 21 days (OR = 2.33, 1.12–4.83, p = 0.0236). Patients with both a LUS and Lateral location were over six times more likely to have PPROM ≤ 21 days (OR = 6.66, 2.36–18.78, p = 0.0003). Trocar insertion site was not associated with PTB.

Conclusion We found that trocar insertion in the LUS, particularly the lateral LUS, was associated with an increased risk of PPROM.

Keywords

laser surgery - trocar - twin–twin transfusion syndrome

Full Text

References

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