Perinatal outcome of twin-to-twin transfusion syndrome complicated with incidental septostomy after laser surgery: a systematic review and meta-analysis.

AIM To evaluate perinatal outcomes of incidental septostomy (IS) after laser therapy for twin-to-twin transfusion syndrome (TTTS), and to compare the outcomes with those who had intact intertwin membrane. METHODS Databases such as PubMed, Web of Science, Scopus, and Embase were systematically searched from inception up to August 2020. The random-effects model was used to pool the mean difference (MD) or odds-ratio (OR) with the corresponding 95% confidence intervals (CIs). Primary outcome was neonatal survival while secondary outcomes included gestational age (GA) at intervention, GA at delivery, preterm delivery, preterm premature rupture of membranes (PPROM). RESULTS Four studies (1442 patients) met our inclusion criteria. Postoperative identification of IS was associated with earlier GA at delivery (MD=-2.52; 95% CI, -3.22, -1.82; P<0.00), higher risk of PPROM<32 weeks (OR=2.82; 95% CI, 1.80, 4.40; P<0.001) and preterm delivery<32 weeks (OR=4.01; 95% CI, 1.27, 12.63; P=0.02). No differences were noted in pseudoamniotic band syndrome, at least one or dual neonatal survival rate between IS and non-IS groups. CONCLUSIONS Occurrence of IS after laser surgery for TTTS is associated with earlier GA at delivery, increased risk for PPROM and preterm delivery<32 weeks' gestation. However, neonatal survival does not appear to be affected by this complication. This article is protected by copyright. All rights reserved.