Maternal complications following open and fetoscopic fetal surgery: A systematic review and meta‐analysis

Adalina Sacco; Lennart Van der Veeken; Emma Bagshaw; Catherine Ferguson; Tim Van Mieghem; Anna L David; Jan Deprest

doi:10.1002/pd.5421

. 2019 Feb 27;39(4):251–268. doi: 10.1002/pd.5421

Maternal complications following open and fetoscopic fetal surgery: A systematic review and meta‐analysis

Adalina Sacco ^1,^✉, Lennart Van der Veeken ², Emma Bagshaw ¹, Catherine Ferguson ¹, Tim Van Mieghem ³, Anna L David ^1,^2,⁴, Jan Deprest ^1,^2,⁵

PMCID: PMC6492015 PMID: 30703262

Abstract

Objective

To establish maternal complication rates for fetoscopic or open fetal surgery.

Methods

We conducted a systematic literature review for studies of fetoscopic or open fetal surgery performed since 1990, recording maternal complications during fetal surgery, the remainder of pregnancy, delivery, and after the index pregnancy.

Results

One hundred sixty‐six studies were included, reporting outcomes for open fetal (n = 1193 patients) and fetoscopic surgery (n = 9403 patients). No maternal deaths were reported. The risk of any maternal complication in the index pregnancy was 20.9% (95%CI, 15.22‐27.13) for open fetal and 6.2% (95%CI, 4.93‐7.49) for fetoscopic surgery. For severe maternal complications (grades III to V Clavien‐Dindo classification of surgical complications), the risk was 4.5% (95% CI 3.24‐5.98) for open fetal and 1.7% (95% CI, 1.19‐2.20) for fetoscopic surgery. In subsequent pregnancies, open fetal surgery increased the risk of preterm birth but not uterine dehiscence or rupture. Nearly one quarter of reviewed studies (n = 175, 23.3%) was excluded for failing to report the presence or absence of maternal complications.

Conclusions

Maternal complications occur in 6.2% fetoscopic and 20.9% open fetal surgeries, with serious maternal complications in 1.7% fetoscopic and 4.5% open procedures.

Reporting of maternal complications is variable. To properly quantify maternal risks, outcomes should be reported consistently across all fetal surgery studies.

Short abstract

What's already known about this topic?

Fetal surgery, both open and fetoscopic, is now widely performed.
Fetoscopy is perceived as safe for the mother, although specific data on maternal complications is lacking.
Open fetal surgery is known to cause maternal morbidity, but the exact nature and frequency of complications is not well established across different centres and types of surgery.

What does this study add?

This study estimates the nature and frequency of maternal complications following fetoscopic and open fetal surgery.
For open fetal surgery, the severe complication rate (grades III to V according to the Clavien‐Dindo classification of surgical complications) is approximately 4% and minor complication rate is 16%.
For fetoscopic fetal surgery, the severe complication rate is approximately 2% and minor complication rate is 4%.

1. INTRODUCTION

The last 35 years have witnessed an expansion of fetal therapy options,1, 2 with surgery on the fetus, placenta, or cord now relatively common in tertiary‐level fetal medicine units. Enabled by advancements in imaging, surgical instrumentation and techniques, early diagnosis, and treatment of fetal anomalies are now possible for a wide range of conditions.3

The mother has been called an “innocent bystander” in fetal surgery,4 and generally, fetal therapy is almost exclusively offered to women who are healthy themselves. Fetal surgery poses risks to the mother not only during the procedure itself but also throughout the remainder of the index pregnancy, potentially during any future pregnancies and throughout the woman's entire life. Fetal surgery offers no direct medical benefit to the mother, and from an ethical perspective, maternal risks should be minor and acceptable to the mother and family.5

Information regarding safety of surgery is important for counselling and informed decision making; however, robust data on maternal complications of fetal surgery are lacking. One single‐centre study of maternal outcomes following both open fetal and fetoscopic surgery performed between 1989 and 2003 found a number of short‐term morbidities.6 A systematic review of maternal complications following fetoscopic laser coagulation for twin‐to‐twin transfusion syndrome (TTTS) in 1785 patients treated between7 1990 and 2009 observed an overall adverse event rate of 5.4% with severe complications in 1.0%. The aim of this study was to estimate the incidence of immediate and long‐term maternal complications of fetoscopic or open fetal surgery through a systematic review of the literature.

What's already known about this topic?

Fetal surgery, both open and fetoscopic, is now widely performed.
Fetoscopy is perceived as safe for the mother, although specific data on maternal complications is lacking.
Open fetal surgery is known to cause maternal morbidity, but the exact nature and frequency of complications is not well established across different centres and types of surgery.

What does this study add?

This study estimates the nature and frequency of maternal complications following fetoscopic and open fetal surgery.
For open fetal surgery, the severe complication rate (grades III to V according to the Clavien‐Dindo classification of surgical complications) is approximately 4% and minor complication rate is 16%.
For fetoscopic fetal surgery, the severe complication rate is approximately 2% and minor complication rate is 4%.

2. METHODS

2.1. Protocol and registration

This systematic review was conducted in accordance with preferred reporting items for systematic reviews and meta‐analyses (PRISMA) guidance.8 The protocol was registered with the international prospective register of systematic reviews (PROSPERO‐CRD42017082411).

2.2. Eligibility criteria

All randomised, cohort, and case‐controlled studies and case series reporting the results of open fetal or fetoscopic fetal surgery in humans from January 1990 to October 2018 were considered eligible. No language restrictions were applied. Systematic reviews, narrative review articles, and case reports were excluded. There is no accepted numerical definition of a case series.9 We used an empirical cut‐off of at least three cases because of the rarity of some procedures and conditions searched for.

2.3. Search strategy

A systematic review was conducted in MEDLINE, EMBASE, and Cochrane databases using free text and Medical Subject Headings (MESH). The electronic search strategy is described in the Supporting Information. Subsequently, a grey literature (first 100 hits in PubMed and Google Scholar) search was performed, and reference lists of relevant review articles were manually checked. Covidence software (Veritas Health Innovation Ltd, Melbourne, Australia) was used to eliminate duplicate articles and manage study screening.

2.4. Study selection

Two authors (A.S. and L.VdV.) screened all titles and abstracts independently, excluded irrelevant studies and then independently assessed the remaining full‐text articles for eligibility; disagreements were resolved by consensus. Studies were excluded if the full text was unavailable online and the abstract contained insufficient information. Studies with interventions which were not fully described or were performed on the neonate instead of the fetus were excluded. Interventions involving access to the uterus using a device with a total outer diameter of less than 1.5 mm were excluded; this cut‐off was chosen to avoid procedures performed with needles only (eg, amniocentesis, fetal blood transfusion, thoracocentesis or vesicocentesis). Studies of shunting were only included if the outer shunt diameter was greater than or equal to 1.5 mm or the shunt was inserted fetoscopically. Studies which did not report maternal outcomes were excluded. For the purpose of this study, preterm rupture of membranes (PROM), chorionic membrane separation (CMS), preterm labour, preterm delivery, and gestational age at delivery, although relevant, were not considered to be maternal complications. Studies from which data could not be extracted (eg, composite or combined outcomes given) and studies containing patient cohorts which appeared to have been published previously by the same authors were excluded.

2.5. Data extraction

Two authors independently extracted data (A.S. and E.B. for open fetal surgery studies, A.S. and C.F. for fetoscopic studies) and entered them into a standardised Excel (Microsoft, Washington, USA) form. Disagreements were resolved by consensus. The ex utero intrapartum treatment (EXIT) procedure was classified as open fetal surgery. Study characteristics noted included study design, underlying fetal condition, type of intervention, presence of a control group, gestational age at surgery, and number of patients in each study. Outcomes recorded for the duration of the index pregnancy included intraoperative complications (maternal death, placental abruption, uterine bleeding/haemorrhage, blood transfusion, organ damage, or anaesthetic complications), post‐operative complications (classified from the end of surgery until delivery; maternal death, placental abruption, uterine bleeding/haemorrhage, blood transfusion, sepsis, chorioamnionitis, other infections, pulmonary oedema, amniotic fluid embolism and other respiratory, gastro‐intestinal, cardiac, or wound problems), complications at delivery of the index pregnancy (uterine dehiscence or rupture or blood transfusion), and the need for additional treatment at any time during the pregnancy. Outcomes noted at any time following the index pregnancy (late outcomes) included fertility (number of further pregnancies, difficulty conceiving, mean time to conception), future pregnancy complications (miscarriage or preterm delivery), complications during future deliveries (uterine dehiscence or rupture or haemorrhage at delivery), gynaecological and psychological symptoms. When a study reported “haemorrhage” or an actual blood loss of greater than 1000 mL we noted this as “haemorrhage.” This cut‐off is an accepted definition of severe bleeding both in pregnancy10 and post‐partum.11 If a study did not specify whether a complication occurred intraoperatively or post‐operatively (eg, placental abruption and requirement for blood transfusion), then this was assumed to have occurred post‐operatively.

All complications were independently graded according to the Clavien‐Dindo classification of surgical complications12 by two authors (A.S. and L.VdV.) (Supporting Information). Clavien‐Dindo grade I or II complications were defined as mild; grades III to V complications were defined as severe.12

2.6. Quality assessment of studies

Study quality and risk of bias were analysed by two authors (A.S. and L.VdV.) independently using a standardised form. Randomised trials were analysed using the Cochrane Collaboration's tool for assessing risk of bias.13 Case‐control studies were analysed using the Newcastle‐Ottawa scale for assessing the quality of nonrandomised studies.14 Case series were analysed using the National Institutes of Health study quality assessment tool.15

2.7. Assessment of heterogeneity

Methodological and clinical heterogeneity of data per study were evaluated. Variables were tested for statistical heterogeneity by applying the I² test to determine whether data could be pooled. An I² value less than 40% was taken to indicate minor heterogeneity; 40% to 75% moderate heterogeneity and greater than 75% substantial heterogeneity.13

2.8. Meta‐analysis

Meta‐analysis for all outcomes was carried out using MedCalc statistical software version 15.4 (MedCalc Software, Ostend, Belgium). Results were expressed as proportions with 95% confidence intervals (CI) as all outcomes were categorical variables. Pooled proportions were calculated using both the fixed and random effects model in case of homogeneity or heterogeneity respectively.

3. RESULTS

3.1. Study selection

The electronic literature search identified 70 367 studies published between 1990 and 2018 (Figure 1); search of the grey literature and reference lists identified a further 16 studies. Following this, 48 248 studies were immediately removed as duplicates. The remaining studies (22 135) were screened by title and abstract, and a further 21 384 were excluded as irrelevant. Full texts of the remaining 751 articles were reviewed, and 585 were excluded for the following reasons: no reporting of maternal outcomes (175/585, 29.9% of studies excluded and 23.3% [175/751] of all studies assessed), insufficient information available (conference abstract/poster only or full text unavailable) (119/585, 20.3%), study design other than randomised trial, case‐control trial or case series (110/585, 18.8%), and uterine access using a device less than 1.5 mm (59/585, 10.1%). Thirty studies were translated from French (10), Spanish (seven), Polish (five), German (three), Dutch (two), Portuguese (two), and Turkish (one), of which 16 were included following review. Two Chinese‐language papers were identified, but the full text could not be accessed online. Eventually, 166 studies were included; 41 on open fetal surgery, 122 on fetoscopic surgery, and three studies including both surgery types.

Flow diagram of study selection adapted from preferred reporting items for systematic reviews and meta‐analyses (PRISMA)8 2009

3.2. Study characteristics

Characteristics of included studies are shown in Tables 1, 2, 3. Studies of open fetal (Table 1) and fetoscopic (Table 2) surgery are presented and analysed separately as the difference in surgical technique was considered too great for combined analysis. Seven studies specifically focused on late complications, ie, after the index pregnancy and are presented separately (Table 3). The majority of studies (68.1%, 113/166) were case series, ie, without a control group; 27.1% (45/166) were case control studies, and 4.8% (8/166) were randomised trials.

Table 1.

Included studies of open fetal surgery

Category	First Author and Year of Publication	Condition	Procedure	Study Design	No of Patients
EXIT	Barthod,16 2013	Neck mass, CHAOS	EXIT	Case series	5
	Cass,17 2013	Lung mass, mediastinal mass	EXIT	Case series	9
	Chen,18 2018	Omphalocele	EXIT	Case control	7
	Dahlgren,19 2004	Head or neck tumour	EXIT	Case series	4
	Flake,20 2000^a	CDH	EXIT	Case series	15
	George,21 2007	Skeletal dysplasia, micrognathia	EXIT	Case series	3
	Hedrick,22 2003	Multiple	EXIT	Case series	43
	Hedrick,23 2005	Lung lesions	EXIT	Case series	9
	Kern,24 2007	CCAM, hydrothorax	EXIT	Case series	5
	Kornacki,25 2017	Neck mass, CHAOS	EXIT	Case series	4
	Kunisaki,26 2007	CDH	EXIT	Case control	14
	Laje,27 2012	Cervical teratoma	EXIT	Case series	17
	Laje,28 2013	Neck mass	EXIT	Case series	4
	Laje,29 2015	Cervical lymphatic mass	EXIT	Case series	13
	Lazar,30 2011	Neck mass	EXIT	Case series	12
	Noah,31 2002	Not stated	EXIT	Case control	34
	Pellicer,32 2007	Neck mass	EXIT	Case series	3
	Stoffan,33 2012	CDH	EXIT	Case control	7
	Tuncay Ozgunen,34 2010	Neck mass	EXIT	Case series	3
	Zamora,35 2013^c	MMC, lung mass, SCT	EXIT	Case series	26
MMC	Bennett,36 2014	MMC	Neurosurgical repair	Case control	43
	Botelho,37 2017	MMC	Neurosurgical repair	Case series	45
	Bruner,38 1999	MMC	Neurosurgical repair	Case control	29
	Bruner,39 2000^c	MMC	Neurosurgical repair	Case control	4
	Farmer,40 2003	MMC	Neurosurgical repair	Case series	12
	Friszer,41 2016	MMC	Neurosurgical repair	Case series	3
	Johnson,42 2016	MMC	Neurosurgical repair	Randomised	91
	Marenco,43 2013	MMC	Neurosurgical repair	Case series	4
	Moldenhauer,44 2015	MMC	Neurosurgical repair	Case series	100
	Moron,45 2018	MMC	Neurosurgical repair	Case series	237
	Ochsenbein‐Kolble,46 2017	MMC	Neurosurgical repair	Case control	30
	Sinskey,47 2017	MMC	Neurosurgical repair	Case series	47
	Soni,48 2016	MMC	Neurosurgical repair	Case series	88
	Zamlynski,49 2014	MMC	Neurosurgical repair	Case control	46
CDH	Flake,20 2000^a	CDH	Tracheal occlusion	Case series	15
	Harrison,50 1990	CDH	Diaphragm repair	Case series	6
	Harrison,51 1993	CDH	Diaphragm repair	Case series	14
	Harrison,52 1998^b	CDH	Tracheal occlusion	Case control	13
CCAM	Adzick,53 2003	CCAM	Lung resection	Case series	22
SCT	Hedrick,54 2004	SCT	Debulking	Case series	4
Mixed	Golombeck,6 2006^a, ^b	MMC, CCAM, SCT	Mixed	Case control	79
	Longaker,55 1991	LUTO, CDH, SCT, CCAM	Mixed	Case series	17
	Zamora,35 2013^c	MMC, lung mass, SCT	Mixed	Case series	7
TOTAL				43 studies	1193 patients

Open in a new tab

Abbreviations: CCAM, congenital cystic adenomatoid malformation; CD, congenital diaphragmatic hernia; CHAOS, congenital high airway obstruction syndrome; EXIT, ex utero intrapartum treatment; LUTO, lower urinary tract obstruction; MMC, myelomeningocele; SCT, sacrococcygeal teratoma.

Studies including patients undergoing a primary fetal and later an EXIT procedure.

Studies including both open and fetoscopic procedures also included in Table 2.

Studies including immediate and late complications also included in Table 3.

Table 2.

Included studies of fetoscopic surgery

Category	First Author and Year of Publication	Condition	Procedure	Study Design	No of Patients
Multiple pregnancy complications treated with laser	Aboudiab,56 2017	TTTS	Laser photocoagulation	Case series	18
	Baschat,57 2013	TTTS	Laser photocoagulation	Case control	147
	Chalouhi,58 2016	TTTS (triplets)	Laser photocoagulation	Case series	22
	Chang,59 2006	TTTS	Laser photocoagulation	Case series	27
	Chang,60 2016	TTTS	Laser photocoagulation	Case control	100
	Chmait,61 2013	TTTS	Laser photocoagulation	Case control	318
	Chmait,62 2017	TTTS	Laser photocoagulation	Case series	19
	Crombleholme,63 2007	TTTS	Laser photocoagulation	Randomised	20
	De Lia,64 1995	TTTS	Laser photocoagulation	Case series	26
	De Lia,65 1999	TTTS	Laser photocoagulation	Case series	67
	De Lia,66 2009	TTTS (triplets)	Laser photocoagulation	Case series	10
	Deprest,67 1998	TTTS	Laser photocoagulation	Case series	6
	Draga,68 2016	TTTS	Laser photocoagulation	Case series	37
	Duron,69 2014	TTTS	Laser photocoagulation	Case control	85
	Ek,70 2012	TTTS	Laser photocoagulation	Case series	67
	Habli,71 2009	TTTS	Laser photocoagulation	Case series	152
	Has,72 2014	TTTS	Laser photocoagulation	Case series	85
	Hecher,73 2000	TTTS	Laser photocoagulation	Case control	200
	Hernandez‐Andrade,74 2011	TTTS	Laser photocoagulation	Case series	35
	Huber,75 2008	TTTS	Laser photocoagulation	Case control	176
	Ishii,76 2014	TTTS (triplets)	Laser photocoagulation	Case series	16
	Ishii,77 2015	sFGR	Laser photocoagulation	Case series	10
	Lanna,78 2017	TTTS	Laser photocoagulation	Case control	373
	Lecointre,79 2017	TTTS	Laser photocoagulation	Case control	200
	Malshe,80 2017	TTTS	Laser photocoagulation	Case series	203
	Martinez,81 2012	TTTS	Laser photocoagulation	Case series	500
	Middeldorp,82 2007	TTTS	Laser photocoagulation	Case series	100
	Miyadahira,83 2018	sFGR	Laser photocoagulation	Case control	67
	Molina‐Garcia,84 2009	TTTS, sFGR	Laser photocoagulation	Case series	22
	Morris,85 2010	TTTS	Laser photocoagulation	Case series	164
	Mullers,86 2015	TTTS	Laser photocoagulation	Case series	105
	Nakata,87 2016	TTTS	Laser photocoagulation	Case series	6
	Nguyen,88 2012	TTTS	Laser photocoagulation	Case series	98
	Ozawa,89 2017	Amniotic fluid discordance	Laser photocoagulation	Case series	11
	Papanna,90 2010	TTTS	Laser photocoagulation	Case control	48
	Papanna,91 2012	TTTS	Laser photocoagulation	Case control	163
	Peeters,92 2014	TTTS	Laser photocoagulation	Case control	338
	Persico,93 2016	TTTS	Laser photocoagulation	Case series	106
	Quintero,94 2000	TTTS	Laser photocoagulation	Case control	92
	Quintero,95 2001	sFGR	Laser photocoagulation	Case series	11
	Rossi,96 2008	TTTS	Laser photocoagulation	Case control	266
	Ruano,97 2009	TTTS	Laser photocoagulation	Case series	19
	Ruegg,98 2018	TTTS	Laser photocoagulation	Case control	37
	Rustico,99 2012	TTTS	Laser photocoagulation	Case series	150
	Said,100 2008	TTTS	Laser photocoagulation	Case series	10
	Senat,101 2004	TTTS	Laser photocoagulation	Randomised	72
	Sepulveda,102 2007	TTTS	Laser photocoagulation	Case series	33
	Shamshirsaz,103 2015	TTTS	Laser photocoagulation	Case control	55
	Slaghekke,104 2014	TTTS	Laser photocoagulation	Randomised	274
	Taniguchi,105 2015	TTTS	Laser photocoagulation	Case series	3
	Tchirikov,106 2011	TTTS	Laser photocoagulation	Case control	80
	Teoh,107 2013	TTTS	Laser photocoagulation	Case series	49
	Thia,108 2017	TTTS	Laser photocoagulation	Case series	5
	Ville,109 1997	TTTS	Laser photocoagulation	Case series	132
	Ville,110 1998	TTTS	Laser photocoagulation	Case control	44
	Weingertner,111 2011	TTTS	Laser photocoagulation	Case series	100
	Wilson,112 2016	TTTS	Laser photocoagulation	Case series	151
	Yamamoto,113 2005	TTTS	Laser photocoagulation	Case series	175
	Yang,114 2010	TTTS	Laser photocoagulation	Case series	30
	Zaretsky,115 2018	TTTS	Laser photocoagulation	Case series	749
	Zhao,116 2016	TTTS	Laser photocoagulation	Case control	62
Multiple pregnancy complications treated with selective reduction	Bebbington,117 2012	TTTS, TRAP, sFGR, discordant anomaly	RFA	Case control	146
	Berg,118 2014	TRAP	RFA	Case control	7
	Delabaere,119 2013	TTTS, TRAP, sFGR, discordant anomaly	BCC, cord compression, cord ligation	Case series	30
	Deprest,120 2000	TTTS, TRAP	BCC	Case series	10
	Gallot,121 2003	TTTS, TRAP	CO	Case series	11
	Gouverneur,122 2009	TTTS, TRAP, sFGR, discordant anomaly	BCC, laser cord photocoagulation	Case series	54
	Gul,123 2008	TTTS, TRAP, discordant anomaly	BCC	Case series	9
	Has,124 2014	TTTS, TRAP, sFGR, discordant anomaly	BCC	Case series	71
	He,125 2010	TTTS, TRAP, sFGR, discordant anomaly	BCC	Case series	14
	Ilagan,126 2008	TTTS, TRAP, discordant anomaly	BCC	Case series	27
	Jelin,127 2010	TRAP	RFA	Case control	7
	King,128 2017	TRAP, discordant anomaly	Laser cord photocoagulation	Case series	43
	Lanna,129 2012	TTTS, TRAP, sFGR, discordant anomaly	BCC	Case series	118
	Lee,130 2013	TRAP	RFA	Case series	98
	Lewi,131 2006	TTTS, TRAP, sFGR, discordant anomaly	Laser cord photocoagulation	Case series	80
	Moise,132 2008	TTTS, discordant anomaly	RFA	Case series	9
	Nobili,133 2013	Discordant anomaly	BCC	Case series	48
	Paramasivam,134 2010	TTTS, TRAP, sFGR, discordant anomaly	RFA	Case series	35
	Peng,135 2016	TTTS, TRAP, sFGR, discordant anomaly, TAPS	BCC	Case control	93
	Quintero,136 1996	TTTS, TRAP, discordant anomaly	CO	Case series	13
	Quintero,137 2006	TRAP	CO or laser photocoagulation	Case control	51
	Roman,138 2010	TTTS, TRAP, sFGR, discordant anomaly	RFA	Case control	60
	Schou,139 2018	TTTS, TRAP, sFGR, discordant anomaly	BCC	Case control	102
	Sugibayashi,140 2016	TRAP	RFA	Case series	40
	Takano,141 2015	TRAP	Laser photocoagulation +/− transection of cord (MCMA)	Case series	10
	Taylor,142 2002	TTTS	BCC	Case series	15
	Tsao,143 2002	TRAP	RFA	Case series	13
	Zhang,144 2018	TRAP	RFA	Case series	25
CDH	Deprest,145 2005	CDH	FETO	Case series	20
	Harrison,52 1998^a	CDH	Tracheal clip	Case control	8
	Harrison,146 2003	CDH	FETO	Randomised	11
	Jani,147 2005	CDH	FETO	Case series	24
	Jani,148 2006	CDH	FETO	Case series	28
	Jani,149 2009	CDH	FETO	Case series	210
	Jimenez,150 2017	CDH	Fetoscopic balloon removal	Case control	201
	Kosinski,151 2017	CDH	FETO	Case series	28
	Manrique,152 2008	CDH	FETO	Case control	11
	Peralta,153 2011	CDH	FETO	Case series	8
	Persico,154 2017	CDH	FETO	Case series	21
	Ruano,155 2012	CDH	FETO	Case control	35
	Ruano,156 2012	CDH	FETO	Randomised	20
	Ruano,157 2013	CDH	FETO	Case control	17
MMC	Arens,158 2017	MMC	Patch	Case series	59
	Belfort,159 2017	MMC	Single layer suture (skin + dura)	Case series	22
	Bruner,39 2000^a	MMC	Maternal skin graft	Case control	4
	Degenhardt,160 2014	MMC	Patch	Case series	51
	Kohn,161 2018	MMC	Patch	Case series	34
	Pedreira,162 2014	MMC	Patch + skin suture	Case series	4
	Pedreira,163 2016	MMC	Patch + skin suture	Case series	10
	Verbeek,164 2012	MMC	Patch	Case control	19
	Ziemann,165 2018	MMC	Patch	Case series	65
LUTO	Morris,166 2013	LUTO	Vesicoamniotic shunting	Randomised	16
	Ruano,167 2010	LUTO	Cystoscopy	Case control	11
	Welsh,168 2003	LUTO	Cystoscopy	Case series	13
Shunts	Cavalheiro,169 2011	Ventriculomegaly	Shunting	Case series	30
Shunts	Mallman,170 2017	Hydrothorax	Shunting	Case series	78
Mixed	Golombeck,6 2006^a	TTTS, TRAP, CDH, LUTO	Mixed	Case control	99
	Kohl,171 2006	MMC, CDH, CHAOS	Mixed	Case series	16
	Kohl,172 2010	MMC, TTTS, CDH, CHAOS, ABS	Mixed	Case series	37
	Nivatpumin,173 2016	TTTS, LUTO, CDH, TRAPS	Mixed	Case series	152
	Peralta,174 2010	TTTS, CDH, TRAP	Mixed	Case series	56
TOTAL				122 studies	9403 patients

Open in a new tab

Abbreviations: BCC, bipolar cord coagulation; CDH, congenital diaphragmatic hernia; CHAOS, congenital high airway obstruction syndrome; CO, cord occlusion; FETO, fetoscopic endoluminal tracheal occlusion; LUTO; lower urinary tract obstruction; MCMA, monochorionic monoamniotic; MMC, myelomeningocele; RFA, cord radiofrequency ablation; sFGR; selective fetal growth restriction; TAPS, twin anaemia‐polycythaemia sequence; TO, tracheal occlusion; TRAP, twin reversed arterial perfusion sequence; TTTS, twin‐to‐twin transfusion syndrome.

Studies including both open and fetoscopic procedures also included in Table 1.

Table 3.

Included studies of open and fetoscopic surgery focusing on late complications

First Author and Year of Publication	Type of Surgery	Condition	Study Design	Number of Patients
Farrell,4 1999	Open	CDH, CCAM, LUTO, SCT,	Case series	45
Thom,175 2016	Open	MMC	Randomised	87
Wilson,176 2010	Open	MMC, CCAM, CDH, SCT, mediastinal teratoma	Case series	47
Zamora,35 2013^a	Open	MMC, lung mass, SCT, EXIT	Case series	33
Gregoir,177 2016	Fetoscopic	CDH	Case control	89
Le Lous,178 2018	Fetoscopic	TTTS	Case control	122
Vergote,179 2018	Fetoscopic	TTTS	Case control	92
TOTAL			7 studies	515 patients

Open in a new tab

Abbreviations: CCAM, congenital cystic adenomatoid malformation; CDH, congenital diaphragmatic hernia; EXIT, ex utero intrapartum treatment; LUTO, lower urinary tract obstruction; MMC, myelomeningocele; SCT, sacrococcygeal teratoma; TTTS, twin‐to‐twin transfusion syndrome.

Studies including immediate and late complications, also included in Table 1.

3.3. Risk of bias

Quality assessment of the studies is given in the Supporting Information. Most studies (139/166, 83.7%) had a low risk of bias or were high quality. All remaining studies (27/166, 16.3%) had an unclear risk of bias or were fair quality. No studies were found to have a high risk of bias or be low quality overall. For randomised trials, included studies had a high risk of bias with regards to blinding. For case control studies, included studies did not describe statistical methods well overall.

3.4. Statistical heterogeneity

Maternal outcome data were pooled in 64 separate meta‐analyses, of which 37.5% (24/64) had no or minor heterogeneity. In 39.1% (25/64), there was moderate heterogeneity, and in 23.4% (15/64), there was considerable heterogeneity. The levels of heterogeneity per outcome measure are listed in the Supporting Information. As both clinical and statistical heterogeneity were found, pooled proportions were given using the random effects model for meta‐analysis.

3.5. Maternal complications in the index pregnancy—intraoperative

Table 4 summarises maternal complications according to type of surgery performed. No maternal deaths (Clavien‐Dindo grade V) due to fetal surgery were reported in any study (10 596 procedures). One study86 reported a patient at 20 weeks' gestation experiencing a cardiorespiratory arrest prior to fetoscopy for laser photocoagulation. The cause was considered to be a combination of morbid obesity, spinal anaesthesia, and aortocaval compression and not related to the procedure, which had not commenced. An immediate delivery was conducted by hysterotomy as part of maternal resuscitation, and the patient made a full recovery. Another study47 reported brief maternal seizure‐like activity during open fetal surgery, which was thought to be anaesthesia‐related.

Table 4.

Maternal complications occurring with open or fetoscopic fetal surgery

	Severe Complications				Minor Complications		All Complications
Clavien‐Dindo classification	IV (requiring ICU care)		III (requiring surgical intervention)		I‐II (requiring treatment)		I‐IV
Open surgery n = 1193	Complication	n	Complication	n	Complication	n	ALL COMPLICATIONS: 20.86% (95% CI, 15.22‐27.13)
	Severe infection	2	Haemorrhage requiring delivery	3	Bleeding during procedure	13
	Pulmonary oedema	4	Placental abruption	28	Transfusion during/after procedure	41
	Complete heart block^a	1	Bowel obstruction	1	Chorioamnionitis/endometritis	45
			Wound drainage	2	Other infections^b	8
			Uterine rupture	5	Pulmonary oedema	50
			Laparotomy/dehiscence repair	1	Transfusion at delivery	17
			Caesarean hysterectomy	1

	TOTAL SEVERE: 4.51% (95% CI, 3.24‐5.98)				TOTAL MINOR: 16.26% (95% CI, 11.17‐22.09)
Fetoscopic surgery n = 9403	Maternal cardiac arrest and delivery by hysterotomy	1	Sepsis requiring delivery	1	Bleeding during procedure	165	ALL COMPLICATIONS: 6.15% (95% CI, 4.93‐7.49)
	Severe infection	2	Haemorrhage requiring delivery	8	Transfusion during/after procedure	16
	Pulmonary oedema	3	Placental abruption	159	Venous thromboembolism^c	2
	Lung collapse	1			Chorioamnionitis	114
	DIC + caesarean hysterectomy	1			Other infections^d	2
	Amniotic fluid embolism	2			Pulmonary oedema	45
					Upper GI bleed^e	1
					Diathermy skin burns	4
					“Epidural headache” + blood patch	1
					Wound hernia	1
					Pleural effusions	1

	TOTAL SEVERE: 1.66% (95% CI, 1.19‐2.20)				TOTAL MINOR: 4.33% (95% CI, 3.33‐5.45)

Open in a new tab

Abbreviations: CI, confidence interval; GI, gastrointestinal; n, number of women. Pooled proportions calculated using random effect model for meta‐analysis.

Complete heart block considered to be tocolysis‐related (magnesium sulphate).

Other infections in open surgery: wound (6), chest (1), urinary tract (1).

Venous thromboembolism: confirmed pulmonary embolism (1); suspected PE with confirmed deep vein thrombosis (1).

Other infections in fetoscopic surgery: wound (1), chest (1).

Upper GI bleed considered to be tocolysis‐related (indomethacin).

Haemorrhage severe enough to prompt delivery or termination of pregnancy at the time of surgery as a life‐saving procedure for the mother (Clavien‐Dindo grade III) occurred in 0.92% of open fetal (95% CI, 0.46‐1.62) and 0.26% of fetoscopic surgeries (95% CI, 0.17‐0.38). Three cases38, 45, 46 occurred because of placental abruption during open fetal surgery for myelomeningocele (MMC) repair, following which delivery occurred, with all three fetuses surviving. Two cases59, 75 occurred following laser photocoagulation for TTTS said to be due to “excessive bleeding from placental anastomoses” and the uterine wall, respectively. Two cases119, 121 occurred during selective reduction, with haemorrhage from the uterine wall prompting delivery. Finally, one pregnancy was terminated because of bleeding from a trocar placental injury during fetoscopic MMC repair.172

In total, placental abruption (Clavien‐Dindo grade III) occurred intraoperatively in 1.28% of open fetal (95% CI, 0.73‐1.98) and in 0.28% of fetoscopic surgeries (95% CI, 0.18‐0.39). Bleeding during the procedure was noted in 1.97% of open fetal (95% CI, 0.97‐3.31) and in 1.74% of fetoscopic surgery cases (95% CI, 1.25‐2.32). Intraoperative blood transfusion was required in 1.00% of patients undergoing open fetal surgery (95% CI, 0.53‐1.64) and in 0.27% undergoing fetoscopic surgery (95% CI, 0.18‐0.38). Intraoperative skin burns at the site of diathermy pads occurred in 0.26% of patients (95% CI, 0.17‐0.37) during fetoscopic surgery; this outcome was not reported in any open fetal surgery.

3.6. Maternal complications in the index pregnancy—postoperative

One study on laser photocoagulation for TTTS (n = 132)110 reported a maternal death from disseminated intravascular coagulation (DIC) 4 weeks following an uneventful procedure. A post‐mortem examination did not find any evidence of chorioamnionitis or amniotic fluid embolism, and the authors therefore concluded that this death was unrelated to the procedure.

Haemorrhage severe enough to prompt return to theatre for termination or delivery of the pregnancy within 24 hours was not reported following any open fetal surgeries but occurred following 0.25% of fetoscopic procedures (95% CI, 0.16‐0.37). This included one171 4‐hour post‐fetoscopic tracheal balloon removal with no cause of the bleeding found. There were two late placental abruptions, one113 12‐hour post‐laser photocoagulation, and one142 within 24 hours of bipolar cord coagulation.

Placental abruption occurred in 1.80% of patients following open fetal (95% CI, 1.14‐2.63) and in 1.29% following fetoscopic surgery (95% CI, 0.90‐1.75). Post‐operative blood transfusion was given to 3.36% after open fetal surgery (95% CI, 1.85‐5.29) and in 0.32% following fetoscopic surgery (95% CI, 0.22‐0.44).

Chorioamnionitis following open fetal surgery or endometritis following an EXIT procedure occurred in 4.13% of women (95% CI, 3.03‐5.40), and in 1.45% undergoing fetoscopic surgery (95% CI, 1.06‐1.90). Of those, PROM was reported to have occurred in 47.78% following open fetal surgery (95% CI, 23.01‐73.16) and in 36.31% following fetoscopic surgery (95% CI, 22.00‐51.99). One study reported severe chorioamnionitis 5 days after bipolar cord coagulation131 with septic shock and acute kidney injury, which resolved leaving 70% residual renal function. Sepsis was also reported in one patient61 with chorioamnionitis following fetoscopic laser photocoagulation and in one patient49 following open MMC repair who developed post‐operative peritonitis requiring an emergency laparotomy and delivery. Post‐operative pneumonia occurred in two patients—one132 following fetoscopic radiofrequency ablation (RFA), necessitating 3 days of intubation and intensive care unit (ICU) care and one requiring ICU admission36 following open MMC repair.

Pulmonary oedema occurred in 4.32% of open fetal surgery cases (95% CI, 2.32‐6.90), and in 0.63% of fetoscopic cases (95% CI, 0.43‐0.87). Three studies in which post‐operative pulmonary oedema occurred reported on perioperative fluid management (3/102, 2.9%), and 33 reported on the use of magnesium sulphate (33/102, 32.4%) without specifically suggesting causality. Six women required ICU admission, with four requiring intubation and ventilation; three following open fetal surgery,6, 20 and three following fetoscopic surgery.69, 87, 99

3.7. Maternal complications in the index pregnancy—at delivery

Only a few fetoscopic surgery studies (4/121 studies, 0.33%) reported findings or complications at delivery. Complications at delivery following open fetal surgery are shown in Table 4. Hysterectomy at or around the time of delivery was reported in two patients (Clavien‐Dindo grade III). In one case,44 caesarean delivery following open MMC repair in a woman with two previous caesareans, intra‐abdominal scarring and friable tissue eventually resulted in hysterectomy. In the second case,99 following laser photocoagulation for TTTS and PROM, a caesarean section was performed at 33 weeks' gestation. A hysterectomy was eventually required because of haemorrhage with DIC, and the patient spent 5 days in ICU, where she also experienced an iatrogenic pneumothorax.

Uterine rupture occurred in 0.90% of patients at delivery following open fetal surgery (excluding EXIT procedures) in the index pregnancy (95% CI, 0.41‐1.59), and uterine dehiscence occurred in 3.67% (95% CI, 2.01‐5.81). Blood transfusion was given to 1.83% of women (95% CI, 1.16‐2.65) at delivery following open fetal surgery.

3.8. Overall maternal complication rates

Table 4 displays maternal complications. In open fetal surgery, there was a 4.51% severe (95% CI, 3.24‐5.98), a 16.26% minor complication rate (95% CI, 11.17‐22.09), and a total complication rate of 20.86% (95% CI, 15.22‐27.13). For fetoscopic surgery, the corresponding rates were: 1.66% severe (95% CI, 1.19‐2.20), 4.33% minor (95% CI, 3.33‐5.45), and 6.15% total complications (95% CI, 4.93‐7.49). Complication rates in the six commonest fetal surgical procedures performed are displayed in Table 5.

Table 5.

Maternal complications according to type of fetal surgery in the six most common procedures

	Severe Complications				Minor Complications		All Complications
Clavien‐Dindo classification	IV (requiring ICU care)		III (requiring surgical intervention)		I‐II (requiring treatment)		I‐IV
EXIT n = 237	Complication	n	Complication	n	Complication	n	ALL COMPLICATIONS: 20.19% (95% CI, 4.93‐7.49)
			Placental abruption	5	Bleeding during procedure	11
					Transfusion during/after procedure	19
					Endometritis	10
					Wound infection	5

	TOTAL SEVERE: 3.62% (95% CI, 1.69‐6.24)				TOTAL MINOR: 17.53% (95% CI, 9.86‐26.86)
Open MMC repair n = 779	Severe infection	2	Haemorrhage requiring delivery	3	Bleeding during procedure	1	ALL COMPLICATIONS: 11.54% (95% CI, 7.73‐15.99)
	Complete heart block	1	Placental abruption	16	Transfusion during/after procedure	5
	Pulmonary oedema	1	Bowel obstruction	1	Chorioamnionitis	21
			Uterine rupture	4	Other infections^a	2
			Caesarean hysterectomy	1	Pulmonary oedema	15
					Transfusion at delivery	16

	TOTAL SEVERE: 3.35% (95% CI, 1.70‐5.53)				TOTAL MINOR: 6.63% (95% CI, 3.63‐10.45)
Fetoscopic MMC repair n = 268			Placental abruption	6	Bleeding during procedure	3	ALL COMPLICATIONS: 12.49% (95% CI, 4.83‐23.06)
					Chorioamnionitis	10
					Pulmonary oedema	5

	TOTAL SEVERE: 2.75% (95% CI, 0.56‐6.52)				TOTAL MINOR: 9.04% (95% CI, 3.27‐17.40)
FETO (insertion or fetoscopic removal of balloon) n = 634			Placental abruption	4	Bleeding during procedure	1	ALL COMPLICATIONS: 3.44% (95% CI, 0.98‐7.32)
					Transfusion during/after procedure	1
					Chorioamnionitis	7
					Wound infection	1
					Pulmonary oedema	3

	TOTAL SEVERE: 1.08% (95% CI, 0.23‐2.54)				TOTAL MINOR: 2.39% (95% CI, 0.71‐5.02)
Fetoscopic laser photo‐coagulation n = 6746	Maternal arrest and delivery	1	Haemorrhage requiring delivery	2	Bleeding during procedure	148	ALL COMPLICATIONS: 5.86% (95% CI, 4.33‐7.61)
	Pulmonary oedema	3	Sepsis requiring delivery	1	Transfusion during/after procedure	9
	Lung collapse	1	Placental abruption	130	VTE^b	2
	Amniotic fluid embolism	2			“Epidural headache” + blood patch	1
	DIC + caesarean hysterectomy	1			Chorioamnionitis	68
					Pulmonary oedema	11
					Upper GI bleed^c	1
					Wound hernia	1

	TOTAL SEVERE: 1.51% (95% CI, 0.91‐2.25)				TOTAL MINOR: 4.03% (95% CI, 2.73‐5.56)
Fetoscopic selective reduction n = 1239	Severe infection	2	Haemorrhage requiring delivery	3	Bleeding during procedure	10	ALL COMPLICATIONS: 5.20% (95% CI, 3.00‐7.96)
			Placental abruption	14	Diathermy skin burns	4
					Chorioamnionitis	19
					Chest infection	1
					Pleural effusion	1

	TOTAL SEVERE: 1.98% (95% CI, 0.97‐3.35)				TOTAL MINOR: 3.00% (95% CI, 1.68‐4.68)

Open in a new tab

Abbreviations: DIC, disseminated intravascular coagulation; EXIT, ex utero intrapartum treatment; FETO, fetoscopic endoluminal tracheal occlusion; GI, gastrointestinal; MMC, myelomeningocele; n, number of women. Pooled proportions calculated using random effect model for meta‐analysis.

Other infections in MMC surgery: chest (1), urinary tract (1).

Venous thromboembolism: confirmed pulmonary embolism (1); suspected PE with confirmed deep vein thrombosis (1).

Upper GI bleed considered to be tocolysis‐related (indomethacin).

3.9. Maternal outcomes following the index pregnancy (long‐term)

Table 6 shows subsequent pregnancy outcomes and long‐term maternal outcomes following a pregnancy in which fetal surgery was performed. New difficulties in conceiving were described in 3.81% of women after open fetal surgery (95% CI, 1.22‐7.76, reported in four studies); this outcome was not reported to occur after fetoscopic surgery (three studies). Pregnancy loss prior to 24 weeks' gestation occurred in 19.95% of pregnancies conceived following open fetal surgery (95% CI, 13.37‐27.48, three studies) and 13.67% of pregnancies conceived after fetoscopic surgery (95% CI, 9.34‐18.68, three studies). Preterm birth occurred in 20.49% of pregnancies following open fetal surgery (95% CI, 10.48‐32.81, four studies) and in 2.12% of pregnancies following fetoscopic surgery (95% CI, 0.02‐9.01; three studies). Uterine rupture or dehiscence occurred, respectively, in 6.89% (95% CI, 1.34‐16.27, reported in three studies) and 11.09% (95% CI, 5.34‐18.59) of pregnancies following open fetal surgery. None were mentioned in fetoscopy studies.

Table 6.

Long‐term maternal complications following open and fetoscopic fetal surgery

		Open Surgery ^a % (95% CI)	Fetoscopic Surgery ^b % (95% CI)
Conception	Women attempting further pregnancy	50.11 (21.55‐78.63)	51.76 (18.63‐84.03)
	Women conceiving further pregnancy	48.33 (26.74‐70.26)	48.20(31.46‐65.16)
	New sub‐fertility	3.81(1.22‐7.76)	NR
Pregnancy outcomes	Miscarriage	19.95 (13.37‐27.48)	13.67 (9.34‐18.68)
	Preterm delivery	20.49 (10.48‐32.81)	2.12 (0.02‐9.01)
	Uterine rupture	6.89 (1.34‐16.27)	0
	Uterine dehiscence	11.09 (5.34‐18.59)	NR
	Excessive bleeding at delivery	6.84 (2.16‐13.88)	5.52 (2.83‐9.03)
Nonpregnancy	Abdominal pain	6.38^b	9.01 (3.84‐16.06)
	Abnormal menstrual bleeding	NR	6.54 (3.43‐10.57)
	Gynaecological surgery^c	8.68 (1.81‐19.96)	NR
	Psychological symptoms	9.09^b	32.56 (7.70‐64.58)

Open in a new tab

Abbreviation: NR, not reported. Pooled proportions calculated using random effect model for meta‐analysis.

Variable denominator as not all outcomes were reported by all studies.

No meta‐analysis possible as reported by single study.

Gynaecological surgery following open fetal surgery: endometrial ablation (1), hysterectomy (6): caesarean hysterectomy (1), ovarian cysts+/−menstrual disorder (2), fibroids (1), unknown reason (2).

4. DISCUSSION

In this systematic review of the literature, we found an overall complication rate of approximately 21% for open fetal surgery and 6% for fetoscopic fetal surgery, of which minor complications occurred in 16% and 4% of surgeries, respectively. This maternal complication rate excludes obstetric complications, which may also have occurred (eg, PROM, CMS, preterm labour, and preterm delivery). Additionally, many studies of fetal surgery fail to document maternal complications. Out of 751 full‐text articles reviewed, 175 (23.3%) were excluded as no maternal outcomes were stated. Although 68 of these studies focused on a specific aspect of the surgery or its neonatal outcome, 107 studies (92 fetoscopic and 15 open) involving over 9000 patients did not comment on the presence or absence of any complications specifically affecting the mother's health. Often, the “maternal outcomes” stated meant in reality obstetric outcomes (eg, PROM and preterm labour). We also found that maternal complications were often presented from the fetal perspective (eg, fetal demise caused by placental abruption). Thirty included studies (18.1%) contained a statement that no adverse maternal outcomes were observed without specifying what was meant by maternal outcomes. Among these studies were some large series, including a study of 201 patients undergoing fetoscopic tracheal balloon removal150 and studies of 20073 and 50081 patients undergoing fetoscopic laser coagulation. It is unlikely that such large numbers of procedures had no maternal complications, and more likely that complications were either not perceived as serious, not reported and/or the patient follow‐up was incomplete. This lack of reporting has most likely led to an underestimation of the actual risk of maternal complications in our meta‐analysis. Conversely, when maternal complications were reported, there was a wide variability in which outcomes were discussed and how they were presented.

There was a severe complication rate (Clavien‐Dindo grade III or IV) of 4.5% in women undergoing open fetal surgery and 1.7% undergoing fetoscopic surgery. This is in keeping with a previous multi‐centre review of maternal complications following laser photocoagulation for TTTS,7 which found a 1.0% rate of severe complications and a 5.4% total rate of complications across all studies; however, when the authors only included studies, which systematically assessed maternal complications as a primary or secondary outcome, this rose to 1.8% for severe and 17.4% for all complications.

In almost all studies of fetal surgery reviewed, long‐term maternal follow up was not described. The seven studies that did so had a wide variation in the parameters described. Fertility does not appear to be negatively affected by fetal surgery, with the rates of de novo difficulties for conceiving in this review (3.81% following open fetal surgery and none following fetoscopic surgery) being comparable, if not less, than published rates of secondary infertility in the general population.180 Similarly, the rates of miscarriage described (19.85% following open fetal and 13.67% following fetoscopic surgery) are similar to rates of spontaneous miscarriage in women who have not undergone fetal surgery.181, 182, 183 Epidemiological studies184 have suggested a worldwide preterm birth rate of 11.1% with a rate of 8.6% in “developed regions.”184 In the United States and United Kingdom, it is estimated at 9.8%185 and 7.3%,186 respectively. The preterm birth rate in this review following open fetal surgery (20.49%) is higher than the usual prevalence, but not higher following fetoscopic surgery (2.12%). Open fetal surgery was followed by uterine rupture or dehiscence in 6.89% and 11.09% of subsequent pregnancies, respectively, which is in line with published rates of rupture (6.2%) and dehiscence (12.5%) following a classical caesarean section.187 Conversely, no uterine ruptures were reported following fetoscopic surgery.

This study included the commonest fetal procedures and, from a maternal perspective, involved similar surgical manipulations yet variable operating times. We included studies from multiple centres worldwide and attempted to identify the non‐English literature. It is therefore likely that these results are generalisable to fetal surgery performed outside the included studies. An obvious weakness of this systematic review is that most studies did not include a control group. Furthermore, we decided to pool data for meta‐analysis despite having high heterogeneity in some results. Another weakness is the extraction of patient data from papers, which is prone to error given the variable reporting; it is possible that some patients had more than one complication and this was not noted or cumulative rates were as a consequence miscalculated.

This systematic review has identified a significant rate of maternal complications, which should be discussed with patients before embarking on fetal surgery. Large studies allow an estimation of the likelihood of these events, insomuch as the cases in these series are unselected and consecutive. Our systematic review search strategy may have missed relevant yet rare complications. For example, a letter to a journal editor describing maternal convulsions during general anaesthesia188 was excluded as a case report according to our criteria. In this circumstance, it appears that the patient was also part of the cohort of a study that was included,47 but it is possible that other rare events published as case reports have been missed. An international, prospective registry of fetal and fetoscopic surgery, such as the Eurofoetus189 and NAFTNet190 registries, would be the best way to accurately determine complication types and rates and avoid missing rare complications.

5. CONCLUSION

The maternal risks of fetal surgery are accepted by many patients and health care professionals for the possible benefit to the fetus.191, 192 This systematic review finds that studies of fetal surgery focus on the fetal outcomes of the procedure, and many fail to describe maternal complications. Fetal surgery comes at a risk to the mother, which may be underestimated by fetal therapists because of under‐reporting and variable reporting quality. In order to properly quantify maternal risks, outcomes should be reported consistently across all studies of fetal surgery, preferentially in prospective registries.

CONFLICT OF INTEREST

All authors report no conflict of interest.

FUNDING INFORMATION

This research is funded by the Wellcome Trust (WT101957) and Engineering and Physical Sciences Research Council (ESPRC) (NS/A000027/1). J.D. is also funded by the Great Ormond Street Hospital Children's Charity Fund. A.L.D. is supported by the National Institute for Health Research University College London Hospitals Biomedical Research Centre. LvdV is funded with support of the Erasmus + Programme of the European Union (Framework Agreement number: 2013‐0040). This publication reflects the views only of the author, and the commission cannot be held responsible for any use, which may be made of the information contained therein.

Supporting information

Data S1: Search Strategy

Table S2: Classification of maternal surgical complications12

Table S3: Summary of risk of bias according to study type.

Table S4: Statistical heterogeneity according to outcome analysed.

Click here for additional data file.^{(113.8KB, docx)}

Data S2. Supporting information

Click here for additional data file.^{(244.4KB, docx)}

Sacco A, Van der Veeken L, Bagshaw E, et al. Maternal complications following open and fetoscopic fetal surgery: A systematic review and meta‐analysis. Prenatal Diagnosis. 2019;39:251–268. 10.1002/pd.5421

REFERENCES

1. Deprest JA, Flake AW, Gratacos E, et al. The making of fetal surgery. Prenat Diagn. 2010;30(7):653‐667. 10.1002/pd.2571 [DOI] [PubMed] [Google Scholar]
2. Jancelewicz T, Harrison MR. A history of fetal surgery. Clin Perinatol. 2009;36(2):227 10.1016/j.clp.2009.03.007‐236 [DOI] [PubMed] [Google Scholar]
3. Deprest JA, Done E, Van Mieghem T, Gucciardo L. Fetal surgery for anesthesiologists. Curr Opin Anaesthesiol. 2008;21(3):298‐307. 10.1097/ACO.0b013e3282ff8607 [DOI] [PubMed] [Google Scholar]
4. Farrell JA, Albanese CT, Jennings RW, Kilpatrick SJ, Bratton BJ, Harrison MR. Maternal fertility is not affected by fetal surgery. Fetal Diagn Ther. 1999;14(3):190‐192. [DOI] [PubMed] [Google Scholar]
5. Moon‐Grady A, Baschat A, Cass D. Fetal treatment 2017: the evolution of fetal therapy centers—a joint opinion from the international fetal medicine and surgical society (IFMSS) and the north American fetal therapy network (NAFTNet). Fetal Diagn Ther. 2017;42(4):241‐248. [DOI] [PMC free article] [PubMed] [Google Scholar]
6. Golombeck K, Ball RH, Lee H, et al. Maternal morbidity after maternal‐fetal surgery. Am J Obstet Gynecol. 2006;194(3):834‐839. [DOI] [PubMed] [Google Scholar]
7. Merz W, Tchatcheva K, Gembruch U, Kohl T. Maternal complications of fetoscopic laser photocoagulation (FLP) for treatment of twin‐twin transfusion syndrome (TTTS). J Perinat Med. 2010;38(4):439‐443. 10.1515/JPM.2010.061 [DOI] [PubMed] [Google Scholar]
8. Moher D, Liberati A, Tetzlaff J, Altman D, The PRISMA Group . Preferred reporting items for systematic reviews and meta‐analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. [DOI] [PMC free article] [PubMed] [Google Scholar]
9. Carey TS, Boden SD. A critical guide to case series reports. Spine (Phila Pa 1976). 2003;28(15):1631‐1634. 10.1097/01.BRS.0000083174.84050.E5 [DOI] [PubMed] [Google Scholar]
10. The Royal College of Obstetricians and Gynaecologists . Antepartum Haemorrhage Green‐top Guideline No. 63. 2011;(63). https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_63.pdf.
11. Gulmezoglu AM, Souza JP, Mathai M. WHO recommendations for the prevention and treatment of postpartum haemorrhage. 2012. 10.1016/j.ijgo.2013.06.024. [DOI]
12. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205‐213. 10.1097/01.sla.0000133083.54934.ae [DOI] [PMC free article] [PubMed] [Google Scholar]
13. Higgins J, Green S. Assessing risk of bias in included studies. Cochrane Handb Syst Rev Interv 2008:187–241.
14. Wells G, Shea B, O'Connell D, Peterson J, Welcho V, Losos M. The Newcastle‐Ottawa scale (NOS) for assessing the quality of nonrandomized studies in meta‐analyses. Ottawa Heal Res Inst 2011. http://www.ohri.ca/programs/clinical_epidemiology/nos_manual.pdf
15. National Institutes of Health: study quality assessment tools. www.nhlbi.nih.gov/health‐topics/study‐quality‐assessment‐tools. Published 2014.
16. Barthod G, Teissier N, Bellarbi N, et al. Fetal airway management on placental support: limitations and ethical considerations in seven cases. J Obstet Gynaecol. 2013;33(8):787‐794. 10.3109/01443615.2013.823924 [DOI] [PubMed] [Google Scholar]
17. Cass DL, Olutoye OO, Cassady CI, et al. EXIT‐to‐resection for fetuses with large lung masses and persistent mediastinal compression near birth. J Pediatr Surg. 2013;48(1):138‐144. 10.1016/j.jpedsurg.2012.10.067 [DOI] [PubMed] [Google Scholar]
18. Chen XY, Yang JX, Zhang HY, et al. Ex utero intrapartum treatment for giant congenital omphalocele. World J Pediatr. 2018;(0123456789);14(4):1‐5. 10.1007/s12519-018-0129-7 [DOI] [PubMed] [Google Scholar]
19. Dahlgren G, Törnberg DC, Pregner K, Irestedt L. Four cases of the ex utero intrapartum treatment (EXIT) procedure: anesthetic implications. Int J Obstet Anesth. 2004;13(3):178‐182. [DOI] [PubMed] [Google Scholar]
20. Flake AW, Crombleholme TM, Johnson MP, Howell LJ, Adzick NS. Treatment of severe congenital diaphragmatic hernia by fetal tracheal occlusion: clinical experience with fifteen cases. Am J Obstet Gynecol. 2000;183(5):1059‐1066. [DOI] [PubMed] [Google Scholar]
21. George RB, Melnick AH, Rose EC, Habib AS. Case series: combined spinal epidural anesthesia for cesarean delivery and ex utero intrapartum treatment procedure. Can J Anaesth. 2007;54(3):218‐222. [DOI] [PubMed] [Google Scholar]
22. Hedrick HL. Ex utero intrapartum therapy. Semin Pediatr Surg. 2003;12(3):190‐195. [DOI] [PubMed] [Google Scholar]
23. Hedrick HL, Flake AW, Crombleholme TM, et al. The ex utero intrapartum therapy procedure for high‐risk fetal lung lesions. J Pediatr Surg. 2005;40(6):1038‐1044. 10.1016/j.jpedsurg.2005.03.024 [DOI] [PubMed] [Google Scholar]
24. Kern C, Ange M, Morales PB, Pfister RE. Ex utero intrapartum treatment (EXIT), a resuscitation option for intra‐thoracic foetal pathologies. Swiss Med Wkly. 2007;137(19–20):279‐285. [DOI] [PubMed] [Google Scholar]
25. Kornacki J, Szydłowski J, Skrzypczak J, et al. Use of ex utero intrapartum treatment procedure in fetal neck and high airway anomalies—report of four clinical cases. J Matern Neonatal Med. 2017;0(0);32(5):1‐5. 10.1080/14767058.2017.1390740 [DOI] [PubMed] [Google Scholar]
26. Kunisaki SM, Barnewolt CE, Estroff JA, et al. Ex utero intrapartum treatment with extracorporeal membrane oxygenation for severe congenital diaphragmatic hernia. J Pediatr Surg. 2007;42(1):98. [DOI] [PubMed] [Google Scholar]
27. Laje P, Johnson MP, Howell LJ, et al. Ex utero intrapartum treatment in the management of giant cervical teratomas. J Pediatr Surg. 2012;47(6):1208‐1216. 10.1016/j.jpedsurg.2012.03.027 [DOI] [PubMed] [Google Scholar]
28. Laje P, Howell LJ, Johnson MP, Hedrick HL, Flake AW, Adzick NS. Perinatal management of congenital oropharyngeal tumors: the ex utero intrapartum treatment (EXIT) approach. J Pediatr Surg. 2013;48(10):2005‐2010. 10.1016/j.jpedsurg.2013.02.031 [DOI] [PubMed] [Google Scholar]
29. Laje P, Peranteau WH, Hedrick HL, et al. Ex utero intrapartum treatment (EXIT) in the management of cervical lymphatic malformation. J Pediatr Surg. 2015;50(2):311‐314. 10.1016/j.jpedsurg.2014.11.024 [DOI] [PubMed] [Google Scholar]
30. Lazar DA, Olutoye OO, Moise KJ, et al. Ex‐utero intrapartum treatment procedure for giant neck masses‐‐fetal and maternal outcomes. J Pediatr Surg. 2011;46(5):817‐822. 10.1016/j.jpedsurg.2011.02.006 [DOI] [PubMed] [Google Scholar]
31. Noah MMS, Norton ME, Sandberg P, Esakoff T, Farrell J, Albanese CT. Short‐term maternal outcomes that are associated with the EXIT procedure, as compared with cesarean delivery. Am J Obstet Gynecol. 2002;186(4):773‐777. [PubMed] [Google Scholar]
32. Pellicer M, Pumarola F, Peiró JL, et al. EXIT procedure in the management of severe foetal airway obstruction. The paediatric otolaryngologist's perspective. Acta Otorrinolaringol Esp. 2007;58(10):487‐490. [PubMed] [Google Scholar]
33. Stoffan AP, Wilson JM, Jennings RW, Wilkins‐Haug LE, Buchmiller TL. Does the ex utero intrapartum treatment to extracorporeal membrane oxygenation procedure change outcomes for high‐risk patients with congenital diaphragmatic hernia? J Pediatr Surg. 2012;47(6):1053‐1057. 10.1016/j.jpedsurg.2012.03.004 [DOI] [PubMed] [Google Scholar]
34. Tuncay Ozgunen F, Kucukgoz Gulec U, Evruke I, Agcabay C, Kadayifci T, Ozcan K. Fetal orofarengeal tumorler ve EXIT islemine dogum hekimi acisindan bakis [the point of view by obstetricians to fetal oropharengal tumors and EXIT procedure: case report]. Turkiye Klin Jinekoloji Obstet. 2010;20(4):247‐251. [Google Scholar]
35. Zamora IJ, Ethun CG, Evans LM, et al. Maternal morbidity and reproductive outcomes related to fetal surgery. J Pediatr Surg. 2013;48(5):951‐955. 10.1016/j.jpedsurg.2013.02.010 [DOI] [PubMed] [Google Scholar]
36. Bennett KA, Carroll MA, Shannon CN, et al. Reducing perinatal complications and preterm delivery for patients undergoing in utero closure of fetal myelomeningocele: further modifications to the multidisciplinary surgical technique. J Neurosurg Pediatr. 2014;14(1):108‐114. 10.3171/2014.3.PEDS13266 [DOI] [PubMed] [Google Scholar]
37. Botelho R, Imada V, Rodrigues da Costa K, Watanabe L, Rossi RJ. Fetal myelomeningocele repair through a mini‐hysterotomy. Fetal Diagn Ther. 2017;42(1):28‐34. [DOI] [PubMed] [Google Scholar]
38. Bruner JP, Tulipan N, Paschall RL, et al. Fetal surgery for myelomeningocele and the incidence of shunt‐dependent hydrocephalus. JAMA. 1999;282(19):1819‐1825. [DOI] [PubMed] [Google Scholar]
39. Bruner JP, Tulipan NB, Richards WO, Walsh WF, Boehm FH, Vrabcak EK. In utero repair of myelomeningocele: a comparison of endoscopy and hysterotomy. Fetal Diagn Ther. 2000;15(2):83‐88. [DOI] [PubMed] [Google Scholar]
40. Farmer DL, von Koch CS, Peacock WJ, et al. In utero repair of myelomeningocele: experimental pathophysiology, initial clinical experience, and outcomes. Arch Surg. 2003;138(8):872‐878. http://www.hlisd.org/LibraryDetail.aspx?LibraryID=3866 [DOI] [PubMed] [Google Scholar]
41. Friszer S, Dhombres F, Di Rocco F, et al. Preliminary results from the French study on prenatal repair for fetal myelomeningoceles (the PRIUM study). J Gynecol Obstet Biol Reprod. 2016;45(7):738‐744. 10.1016/j.jgyn.2015.09.002 [DOI] [PubMed] [Google Scholar]
42. Johnson MP, Bennett KA, Rand L, et al. The management of myelomeningocele study: obstetrical outcomes and risk factors for obstetrical complications following prenatal surgery. Am J Obstet Gynecol. 2016;215(6):778 10.1016/j.ajog.2016.07.052 [DOI] [PMC free article] [PubMed] [Google Scholar]
43. Marenco ML, Márquez J, Ontanilla A, et al. Intrauterine myelomeningocele repair: experience of the fetal medicine and therapy program of the Virgen de Rocío University hospital. Rev Esp Anestesiol Reanim. 2013;60(1):47‐53. 10.1016/j.redar.2012.07.011 [DOI] [PubMed] [Google Scholar]
44. Moldenhauer JS, Soni S, Rintoul NE, et al. Fetal myelomeningocele repair: the post‐MOMS experience at the Children's Hospital of Philadelphia. Fetal Diagn Ther. 2015;37(3):235‐240. 10.1159/000365353 [DOI] [PubMed] [Google Scholar]
45. Moron A, Barbosa M, Milani H, et al. Perinatal outcomes after open fetal surgery for myelomeningocele repair: a retrospective cohort study. BJOG. 2018; 125(10):1280‐1286. [Epub ahea. 10.1111/1471-0528.15312 [DOI] [PMC free article] [PubMed] [Google Scholar]
46. Ochsenbein‐Kölble N, Krähenmann F, Hüsler M, et al. Tocolysis for in utero surgery: atosiban performs distinctly better than magnesium sulfate. Fetal Diagn Ther. 2017. 10.1159/000478261;44(1):59‐64. [DOI] [PubMed] [Google Scholar]
47. Sinskey JL, Rollins MD, Whitlock E, et al. Incidence and management of umbilical artery flow abnormalities during open fetal surgery. Fetal Diagn Ther. 2017. 10.1159/000477963;43(4):274‐283. [DOI] [PubMed] [Google Scholar]
48. Soni S, Moldenhauer JS, Spinner SS, et al. Chorioamniotic membrane separation and preterm premature rupture of membranes complicating in utero myelomeningocele repair. Am J Obstet Gynecol. 2016;214(5):647 10.1016/j.ajog.2015.12.003 [DOI] [PubMed] [Google Scholar]
49. Zamlynski J, Olejek A, Tomasz K. Comparison of prenatal and postnatal treatments of spina bifida in Poland—a non‐randomized, single‐center study. J Matern Neonatal Med. 2014;27(14):1409‐1417. [DOI] [PubMed] [Google Scholar]
50. Harrison MR, Langer JC, Adzick NS, et al. Correction of congenital diaphragmatic hernia in utero, V. Initial clinical experience. J Pediatr Surg. 1990;25(1):47‐57. [DOI] [PubMed] [Google Scholar]
51. Harrison MR, Adzick NS, Flake AW, et al. Correction of congenital diaphragmatic hernia in utero: VI. Hard‐earned lessons. J Pediatr Surg. 1993;28(10):1411‐1418. [DOI] [PubMed] [Google Scholar]
52. Harrison MR, Mychaliska GB, Albanese CT, et al. Correction of congenital diaphragmatic hernia in utero IX: fetuses with poor prognosis (liver herniation and low lung‐to‐head ratio) can be saved by fetoscopic temporary tracheal occlusion. J Pediatr Surg. 1998;33(7):1017‐1023. [DOI] [PubMed] [Google Scholar]
53. Adzick NS, Flake AW, Crombleholme TM. Management of congenital lung lesions. Semin Pediatr Surg. 2003;12(1):10‐16. [DOI] [PubMed] [Google Scholar]
54. Hedrick HL, Flake AW, Crombleholme TM, et al. Sacrococcygeal teratoma: prenatal assessment, fetal intervention, and outcome. J Pediatr Surg. 2004;39(3):430‐438. [DOI] [PubMed] [Google Scholar]
55. Longaker MT, Golbus MS, Filly RA, Rosen MA, Chang SW, Harrison MR. Maternal outcome after open fetal surgery. A review of the first 17 human cases. JAMA. 1991;265(6):737‐741. http://www.hlisd.org/LibraryDetail.aspx?LibraryID=3866 [PubMed] [Google Scholar]
56. Aboudiab MS, Chon AH, Korst LM, Llanes A, Ouzounian JG, Chmait RH. Management of twin–twin transfusion syndrome with an extremely short cervix. J Obstet Gynaecol. 2018;38(3):359‐362. 10.1080/01443615.2017.1330324 [DOI] [PubMed] [Google Scholar]
57. Baschat AA, Barber J, Pedersen N, Turan OM, Harman CR. Outcome after fetoscopic selective laser ablation of placental anastomoses vs equatorial laser dichorionization for the treatment of twin‐to‐twin transfusion syndrome. Am J Obstet Gynecol. 2013;209(3):234 10.1016/j.ajog.2013.05.034 [DOI] [PubMed] [Google Scholar]
58. Chalouhi GE, Quibel T, Benzina N, Bernard J‐P, Essaoui M, Ville Y. Outcome of triplet pregnancies managed for twin‐to‐twin transfusion syndrome: A single center experience. J Gynecol Obstet Biol Reprod. 2016;45(8):929‐935. 10.1016/j.jgyn.2015.08.006 [DOI] [PubMed] [Google Scholar]
59. Chang J, Tracy TF, Carr SR, Sorrells DL, Luks FI. Port insertion and removal techniques to minimize premature rupture of the membranes in endoscopic fetal surgery. J Pediatr Surg. 2006;41(5):905‐909. [DOI] [PubMed] [Google Scholar]
60. Chang Y‐L, Chao A‐S, Chang S‐D, et al. Outcome of twin‐twin transfusion syndrome treated by laser therapy in Taiwan's single center: role of Quintero staging system. Taiwan J Obstet Gynecol. 2016;55(5):700‐704. 10.1016/j.tjog.2015.05.006 [DOI] [PubMed] [Google Scholar]
61. Chmait RH, Korst LM, Llanes A, Mullin P, Lee RH, Ouzounian JG. Perioperative characteristics associated with preterm birth in twin‐twin transfusion syndrome treated by laser surgery. Am J Obstet Gynecol. 2013;209(3):264 10.1016/j.ajog.2013.05.025 [DOI] [PubMed] [Google Scholar]
62. Chmait RH, Kontopoulos EV, Chon AH, Korst LM, Llanes A, Quintero RA. Amniopatch treatment of iatrogenic preterm premature rupture of membranes (iPPROM) after fetoscopic laser surgery for twin–twin transfusion syndrome. J Matern Neonatal Med. 2017;30(11):1349‐1354. 10.1080/14767058.2016.1214123 [DOI] [PubMed] [Google Scholar]
63. Crombleholme TM, Shera D, Lee H, et al. A prospective, randomized, multicenter trial of amnioreduction vs selective fetoscopic laser photocoagulation for the treatment of severe twin‐twin transfusion syndrome. Am J Obstet Gynecol. 2007;197(4):396. [DOI] [PMC free article] [PubMed] [Google Scholar]
64. De Lia JE, Kuhlmann RS, Harstad TW, Cruikshank DP. Fetoscopic laser ablation of placental vessels in severe previable twin‐twin transfusion syndrome. Am J Obstet Gynecol. 1995;172(4):1202. [DOI] [PubMed] [Google Scholar]
65. De Lia JE, Kuhlmann RS, Lopez KP. Treating previable twin‐twin transfusion syndrome with fetoscopic laser surgery: outcomes following the learning curve. J Perinat Med. 1999;27(1):61‐67. [DOI] [PubMed] [Google Scholar]
66. De Lia JE, Worthington D, Carr MH, Graupe MH, Melone PJ. Placental laser surgery for severe previable feto‐fetal transfusion syndrome in triplet gestation. Am J Perinatol. 2009;26(8):559‐564. 10.1055/s-0029-1220789 [DOI] [PubMed] [Google Scholar]
67. Deprest JA, Van Schoubroeck D, Van Ballaer PP, Flageole H, Van Assche FA, Vandenberghe K. Alternative technique for Nd: YAG laser coagulation in twin‐to‐twin transfusion syndrome with anterior placenta. Ultrasound Obstet Gynecol. 1998;11(5):347‐352. [DOI] [PubMed] [Google Scholar]
68. Draga E, Janiak K, Bielak A, et al. Fetal therapy‐laser therapy of twin‐to‐twin transfusion syndrome/TTTS/. Polish Gynaecol. 2016;87(02):104‐110. 10.17772/gp/61328 [DOI] [Google Scholar]
69. Duron VD, Watson‐Smith D, Benzuly SE, et al. Maternal and fetal safety of fluid‐restrictive general anesthesia for endoscopic fetal surgery in monochorionic twin gestations. J Clin Anesth. 2014;26(3):184‐190. 10.1016/j.jclinane.2013.10.010 [DOI] [PubMed] [Google Scholar]
70. Ek S, Kublickas M, Bui T‐H, et al. Establishing a national program for fetoscopic guided laser occlusion for twin‐to‐twin transfusion syndrome in Sweden. Acta Obstet Gynecol Scand. 2012;91(10):1196‐1200. 10.1111/j.1600-0412.2012.01447.x [DOI] [PubMed] [Google Scholar]
71. Habli M, Bombrys A, Lewis D, et al. Incidence of complications in twin‐twin transfusion syndrome after selective fetoscopic laser photocoagulation: a single‐center experience. Am J Obstet Gynecol. 2009;201(4):417 10.1016/j.ajog.2009.07.046 [DOI] [PubMed] [Google Scholar]
72. Has R, Kalelioglu I, Corbacioglu Esmer A, et al. Stage‐related outcome after fetoscopic laser ablation in twin‐to‐twin transfusion syndrome. Fetal Diagn Ther. 2014;36(4):287‐292. 10.1159/000362385 [DOI] [PubMed] [Google Scholar]
73. Hecher K, Diehl W, Zikulnig L, Vetter M, Hackelöer BJ. Endoscopic laser coagulation of placental anastomoses in 200 pregnancies with severe mid‐trimester twin‐to‐twin transfusion syndrome. Eur J Obstet Gynecol Reprod Biol. 2000;92(1):135‐139. [DOI] [PubMed] [Google Scholar]
74. Hernández‐Andrade E, Guzmán‐Huerta M, Benavides‐Serralde JA, et al. Laser ablation of the placental vascular anastomoses for the treatment of twin‐to‐twin transfusion syndrome. Rev Invest Clin. 2011;63(1):46‐52. [PubMed] [Google Scholar]
75. Huber A, Baschat AA, Bregenzer T, et al. Laser coagulation of placental anastomoses with a 30 degrees fetoscope in severe mid‐trimester twin‐twin transfusion syndrome with anterior placenta. Ultrasound Obstet Gynecol. 2008;31(4):412‐416. 10.1002/uog.5283 [DOI] [PubMed] [Google Scholar]
76. Ishii K, Nakata M, Wada S, Hayashi S, Murakoshi T, Sago H. Perinatal outcome after laser surgery for triplet gestations with feto‐fetal transfusion syndrome. Prenat Diagn. 2014;34(8):734‐738. 10.1002/pd.4357 [DOI] [PubMed] [Google Scholar]
77. Ishii K, Nakata M, Wada S, Murakoshi T, Sago H. Feasibility and preliminary outcomes of fetoscopic laser photocoagulation for monochorionic twin gestation with selective intrauterine growth restriction accompanied by severe oligohydramnios. J Obstet Gynaecol Res. 2015;41(11):1732‐1737. 10.1111/jog.12827 [DOI] [PubMed] [Google Scholar]
78. Lanna MM, Faiola S, Consonni D, Rustico MA. Increased risk of placental abruption after Solomon laser treatment of twin‐twin transfusion syndrome. Placenta. 2017;53:54‐56. 10.1016/j.placenta.2017.03.018 [DOI] [PubMed] [Google Scholar]
79. Lecointre L, Sananès N, Weingertner AS, et al. Photocoagulation laser par fœtoscopie pour syndrome transfuseur‐transfusé: analyse d'une série consécutive unicentrique de 200 cas. J Gynecol Obstet Hum Reprod. 2017;46(2):175‐181. 10.1016/j.jogoh.2016.10.004 [DOI] [PubMed] [Google Scholar]
80. Malshe A, Snowise S, Mann LK, et al. Preterm delivery after fetoscopic laser surgery for twin‐twin transfusion syndrome: etiology and risk factors. Ultrasound Obstet Gynecol. 2017;49(5):612‐616. 10.1002/uog.15972 [DOI] [PubMed] [Google Scholar]
81. Martínez JM, Eixarch E, Crispi F, Puerto B, Gratacós E. Tratamiento por fetoscopia de la transfusión feto‐fetal: resultados en 500 casos consecutivos. Diagnostico Prenat. 2012;23(3):102‐108. 10.1016/j.diapre.2012.06.010 [DOI] [Google Scholar]
82. Middeldorp JM, Sueters M, Lopriore E, et al. Fetoscopic laser surgery in 100 pregnancies with severe twin‐to‐twin transfusion syndrome in the Netherlands. Fetal Diagn Ther. 2007;22(3):190‐194. [DOI] [PubMed] [Google Scholar]
83. Miyadahira M, Brizot M, Carvalho M, et al. Type II and III selective fetal growth restriction: perinatal outcomes of expectant management and laser ablation of placental vessels. Clinics. 2018;73:1‐5. 10.6061/clinics/2018/e210 [DOI] [PMC free article] [PubMed] [Google Scholar]
84. Molina García FS, Zaragoza García E, Carrillo Badillo MP, Fernández de Santos AG, Calpena García A, Montoya Ventoso F. Implementación de la terapia láser endoscópica para las complicaciones de gestaciones gemelares monocoriales. Progresos en Obstet y Ginecol. 2009;52(6):313‐319. 10.1016/S0304-5013(09)71466-9 [DOI] [Google Scholar]
85. Morris RK, Selman TJ, Harbidge A, Martin WI, Kilby MD. Fetoscopic laser coagulation for severe twin‐to‐twin transfusion syndrome: factors influencing perinatal outcome, learning curve of the procedure and lessons for new centres. BJOG. 2010;117(11):1350‐1357. 10.1111/j.1471-0528.2010.02680.x [DOI] [PubMed] [Google Scholar]
86. Müllers SM, McAuliffe FM, Kent E, et al. Outcome following selective fetoscopic laser ablation for twin to twin transfusion syndrome: an 8 year national collaborative experience. Eur J Obstet Gynecol Reprod Biol. 2015;191:125‐129. 10.1016/j.ejogrb.2015.05.019 [DOI] [PubMed] [Google Scholar]
87. Nakata M, Ishii K, Sumie M, et al. A prospective pilot study of fetoscopic laser surgery for twin‐to‐twin transfusion syndrome between 26 and 27 weeks of gestation. Taiwan J Obstet Gynecol. 2016;55(4):512‐514. 10.1016/j.tjog.2016.06.002 [DOI] [PubMed] [Google Scholar]
88. Nguyen HK, Cheng YW, Lee H, et al. 446: recent experience with twin‐twin transfusion syndrome: 2005‐2011. Am J Obstet Gynecol. 2012;206(1):S205 10.1016/j.ajog.2011.10.464 [DOI] [Google Scholar]
89. Ozawa K, Sugibayashi R, Wada S, et al. Fetoscopic laser photocoagulation for amniotic fluid discordance bordering on twin–twin transfusion syndrome: feasibility, perinatal and long‐term outcomes. J Obstet Gynaecol Res. 2017;43(8):1256‐1262. 10.1111/jog.13349 [DOI] [PubMed] [Google Scholar]
90. Papanna R, Johnson A, Ivey RT, Olutoye OO, Cass D, Moise KJ. Laparoscopy‐assisted fetoscopy for laser surgery in twin‐twin transfusion syndrome with anterior placentation. Ultrasound Obstet Gynecol. 2010;35(1):65‐70. 10.1002/uog.7495 [DOI] [PubMed] [Google Scholar]
91. Papanna R, Habli M, Baschat AA, et al. Cerclage for cervical shortening at fetoscopic laser photocoagulation in twin‐twin transfusion syndrome. Am J Obstet Gynecol. 2012;206(5):425 10.1016/j.ajog.2012.02.022 [DOI] [PubMed] [Google Scholar]
92. Peeters SHP, Stolk TT, Slaghekke F, et al. Iatrogenic perforation of intertwin membrane after laser surgery for twin‐to‐twin transfusion syndrome. Ultrasound Obstet Gynecol. 2014;44(5):550‐556. 10.1002/uog.13445 [DOI] [PubMed] [Google Scholar]
93. Persico N, Fabietti I, D'Ambrosi F, Riccardi M, Boito S, Fedele L. Postnatal survival after endoscopic equatorial laser for the treatment of twin‐to‐twin transfusion syndrome. Am J Obstet Gynecol. 2016;214(4):533 10.1016/j.ajog.2015.10.020 [DOI] [PubMed] [Google Scholar]
94. Quintero RA, Comas C, Bornick PW, Allen MH, Kruger M. Selective versus non‐selective laser photocoagulation of placental vessels in twin‐to‐twin transfusion syndrome. Ultrasound Obstet Gynecol. 2000;16(3):230‐236. http://onlinelibrary.wiley.com/doi/10.1046/j.1469‐0705.2000.00265.x/full [DOI] [PubMed] [Google Scholar]
95. Quintero RA, Bornick PW, Allen MH, Johson PK. Selective laser photocoagulation of communicating vessels in severe twin‐twin transfusion syndrome in women with an anterior placenta. Obstet Gynecol. 2001;97(3):477‐481. [DOI] [PubMed] [Google Scholar]
96. Rossi AC, Kaufman MA, Bornick PW, Quintero RA. General vs local anesthesia for the percutaneous laser treatment of twin‐twin transfusion syndrome. Am J Obstet Gynecol. 2008;199(2):137 10.1016/j.ajog.2007.12.008 [DOI] [PubMed] [Google Scholar]
97. Ruano R, de Lourdes Brizot M, Liao AW, Zugaib M. Selective fetoscopic laser photocoagulation of superficial placental anastomoses for the treatment of severe twin‐twin transfusion syndrome. Clinics (Sao Paulo). 2009;64(2):91‐96. http://europepmc.org/search?query=(DOI:%2210.1590/S1807‐59322009000200005%22) [DOI] [PMC free article] [PubMed] [Google Scholar]
98. Rüegg L, Hüsler M, Krähenmann F, Natalucci G, Zimmermann R, Ochsenbein‐Kölble N. Outcome after fetoscopic laser coagulation in twin–twin transfusion syndrome—is the survival rate of at least one child at 6 months of age dependent on preoperative cervical length and preterm prelabour rupture of fetal membranes? J Matern Neonatal Med. 2018;0(0);1‐9. 10.1080/14767058.2018.1506441 [DOI] [PubMed] [Google Scholar]
99. Rustico MA, Lanna MM, Faiola S, et al. Fetal and maternal complications after selective fetoscopic laser surgery for twin‐to‐twin transfusion syndrome: a single‐center experience. Fetal Diagn Ther. 2012;31(3):170‐178. 10.1159/000336227 [DOI] [PubMed] [Google Scholar]
100. Said S, Flood K, Breathnach F, et al. Fetoscopic laser treatment of twin‐to‐twintransfusion syndrome (TTTS). Ir Med J. 2008;101(6):191‐193. [PubMed] [Google Scholar]
101. Senat M‐V, Deprest J, Boulvain M, Paupe A, Winer N, Ville Y. Endoscopic laser surgery versus serial amnioreduction for severe twin‐to‐twin transfusion syndrome. N Engl J Med. 2004;351(2):136‐144. [DOI] [PubMed] [Google Scholar]
102. Sepulveda W, Wong AE, Dezerega V, Devoto JC, Alcalde JL. Endoscopic laser surgery in severe second‐trimester twin‐twin transfusion syndrome: a three‐year experience from a Latin American center. Prenat Diagn. 2007;27(11):1033‐1038. [DOI] [PubMed] [Google Scholar]
103. Shamshirsaz AA, Javadian P, Ruano R, et al. Comparison between laparoscopically assisted and standard fetoscopic laser ablation in patients with anterior and posterior placentation in twin‐twin transfusion syndrome: a single center study. Prenat Diagn. 2015;35(4):376‐381. 10.1002/pd.4552 [DOI] [PubMed] [Google Scholar]
104. Slaghekke F, Lopriore E, Lewi L, et al. Fetoscopic laser coagulation of the vascular equator versus selective coagulation for twin‐to‐twin transfusion syndrome: an open‐label randomised controlled trial. Lancet. 2014;383(9935):2144‐2151. 10.1016/S0140-6736(13)62419-8 [DOI] [PubMed] [Google Scholar]
105. Taniguchi K, Sumie M, Sugibayashi R, Wada S, Matsuoka K, Sago H. Twin anemia‐polycythemia sequence after laser surgery for twin‐twin transfusion syndrome and maternal morbidity. Fetal Diagn Ther. 2015;37(2):148‐153. 10.1159/000365812 [DOI] [PubMed] [Google Scholar]
106. Tchirikov M, Oshovskyy V, Steetskamp J, Falkert A, Huber G, Entezami M. Neonatal outcome using ultrathin fetoscope for laser coagulation in twin‐to‐twin‐transfusion syndrome. J Perinat Med. 2011;39(6):725‐730. 10.1515/JPM.2011.091 [DOI] [PubMed] [Google Scholar]
107. Teoh M, Walker S, Cole S, Edwards A. “A problem shared is a problem halved”: success of a statewide collaborative approach to fetal therapy. Outcomes of fetoscopic laser photocoagulation for twin‐twin transfusion syndrome in Victoria. Aust N Z J Obstet Gynaecol. 2013;53(2):108‐113. 10.1111/ajo.12062 [DOI] [PubMed] [Google Scholar]
108. Thia E, Thain S, Yeo G. Fetoscopic laser photocoagulation in twin‐to‐twin transfusion syndrome: experience from a single institution. Singapore Med J. 2017;58(6):321‐326. 10.11622/smedj.2016067 [DOI] [PMC free article] [PubMed] [Google Scholar]
109. Ville Y, Van Peborgh P, Gagnon A, Frydman R, Fernandez H. Surgical treatment of twin‐to‐twin transfusion syndrome: coagulation of anastomoses with a Nd:YAG laser, under endosonographic control. Forty four cases. J Gynecol Obstet Biol Reprod. 1997;26(2):175‐181. [PubMed] [Google Scholar]
110. Ville Y, Hecher K, Gagnon A, Sebire N, Hyett J, Nicolaides K. Endoscopic laser coagulation in the management of severe twin‐to‐twin transfusion syndrome. Br J Obstet Gynaecol. 1998;105(4):446‐453. [DOI] [PubMed] [Google Scholar]
111. Weingertner A‐S, Kohler A, Mager C, et al. Fetoscopic laser coagulation in 100 consecutive monochorionic pregnancies with severe twin‐to‐twin transfusion syndrome. J Gynecol Obstet Biol Reprod. 2011;40(5):444‐451. 10.1016/j.jgyn.2011.04.001 [DOI] [PubMed] [Google Scholar]
112. Wilson I, Henry A, Hinch E, et al. Audit of immediate outcomes for MCDA twins following laser therapy for twin‐twin transfusion syndrome at the NSW fetal therapy centre. Aust N Z J Obstet Gynaecol. 2016;56(3):289‐294. 10.1111/ajo.12464 [DOI] [PubMed] [Google Scholar]
113. Yamamoto M, El Murr L, Robyr R, Leleu F, Takahashi Y, Ville Y. Incidence and impact of perioperative complications in 175 fetoscopy‐guided laser coagulations of chorionic plate anastomoses in fetofetal transfusion syndrome before 26 weeks of gestation. Am J Obstet Gynecol. 2005;193(3):1110‐1116. [DOI] [PubMed] [Google Scholar]
114. Yang X, Leung TY, Ngan Kee WD, Chen M, Chan LW, Lau TK. Fetoscopic laser photocoagulation in the management of twin‐twin transfusion syndrome: local experience from Hong Kong. Hong Kong Med J. 2010;16(4):275‐281. [PubMed] [Google Scholar]
115. Zaretsky MV, Tong SH, Lagueux M, et al. North American fetal therapy network: indications for delivery following laser ablation for twin‐twin transfusion syndrome. Am J Obstet Gynecol. 2018;218(1):S316‐S316. 10.1016/j.ajog.2017.11.055 [DOI] [PMC free article] [PubMed] [Google Scholar]
116. Zhao D, Cohen D, Middeldorp JM, et al. Histologic chorioamnionitis and funisitis after laser surgery for twin‐twin transfusion syndrome. Obstet Gynecol. 2016;128(2):304‐312. 10.1097/AOG.0000000000001469 [DOI] [PubMed] [Google Scholar]
117. Bebbington MW, Danzer E, Moldenhauer J, Khalek N, Johnson MP. Radiofrequency ablation vs bipolar umbilical cord coagulation in the management of complicated monochorionic pregnancies. Ultrasound Obstet Gynecol. 2012;40(3):319‐324. 10.1002/uog.11122 [DOI] [PubMed] [Google Scholar]
118. Berg C, Holst D, Mallmann MR, Gottschalk I, Gembruch U, Geipel A. Early vs late intervention in twin reversed arterial perfusion sequence. Ultrasound Obstet Gynecol. 2014;43(1):60‐64. 10.1002/uog.12578 [DOI] [PubMed] [Google Scholar]
119. Delabaere A, Favre N, Velemir L, et al. Suivi pédiatrique de 30 grossesses gémellaires monochoriales consécutives traitées par fœticide sélectif. Gynecol Obstet Fertil. 2013;41(2):85‐89. 10.1016/j.gyobfe.2012.12.007 [DOI] [PubMed] [Google Scholar]
120. Deprest JA, Audibert F, Van Schoubroeck D, Hecher K, Mahieu‐Caputo D. Bipolar coagulation of the umbilical cord in complicated monochorionic twin pregnancy. Am J Obstet Gynecol. 2000;182(2):340‐345. 10.1016/S0002-9378(00)70221-3 [DOI] [PubMed] [Google Scholar]
121. Gallot D, Laurichesse H, Lemery D. Selective feticide in monochorionic twin pregnancies by ultrasound‐guided umbilical cord occlusion. Ultrasound Obstet Gynecol. 2003;22(5):484‐488. 10.1002/uog.917 [DOI] [PubMed] [Google Scholar]
122. Gouverneur M, Klumper F, Loproire E, Vandenbussche F, Oepkes D. Selectieve foeticide door navelstrengcoagulatie bij afwijkende monochoriale meerlingen. Ned Tijdschr Geneeskd. 2009;153(19):906‐911. [PubMed] [Google Scholar]
123. Gül A, Güngördük K, Yildirim G, et al. Bipolar cord coagulation in monochorionic twins discordant for major fetal anomalies. J Turkish Ger Gynecol Assoc. 2008;9(1):24‐28. [Google Scholar]
124. Has R, Kalelioglu I, Esmer AC, et al. Bipolar cord coagulation in the management of complicated monochorionic twin pregnancies. Fetal Diagn Ther. 2014;36(3):190‐195. 10.1159/000360853 [DOI] [PubMed] [Google Scholar]
125. He ZM, Fang Q, Yang YZ, et al. Fetal reduction by bipolar cord coagulation in managing complicated monochorionic multiple pregnancies: preliminary experience in China. Chin Med J (Engl). 2010;123(5):549‐554. 10.3760/cma.j.issn.0366-6999.2010.05.008 [DOI] [PubMed] [Google Scholar]
126. Ilagan JG, Wilson RD, Bebbington M, et al. Pregnancy outcomes following bipolar umbilical cord cauterization for selective termination in complicated monochorionic multiple gestations. Fetal Diagn Ther. 2008;23(2):153‐158. 10.1159/000111598 [DOI] [PubMed] [Google Scholar]
127. Jelin E, Hirose S, Rand L, et al. Perinatal outcome of conservative management versus fetal intervention for twin reversed arterial perfusion sequence with a small acardiac twin. Fetal Diagn Ther. 2010;27(3):138‐141. 10.1159/000295176 [DOI] [PubMed] [Google Scholar]
128. King JR, Conturie CL, Ouzounian JG, Korst LM, Llanes A, Chmait RH. Umbilical cord occlusion via laser coagulation in monochorionic multifetal gestations before and after 20 weeks of gestation. Fetal Diagn Ther. 2017;42(1):9‐16. 10.1159/000448948 [DOI] [PubMed] [Google Scholar]
129. Lanna MM, Rustico MA, Dell'Avanzo M, et al. Bipolar cord coagulation for selective feticide in complicated monochorionic twin pregnancies: 118 consecutive cases at a single center. Ultrasound Obstet Gynecol. 2012;39(4):407‐413. 10.1002/uog.11073 [DOI] [PubMed] [Google Scholar]
130. Lee H, Bebbington M, Crombleholme TM. The North American fetal therapy network registry data on outcomes of radiofrequency ablation for twin‐reversed arterial perfusion sequence. Fetal Diagn Ther. 2013;33(4):224‐229. 10.1159/000343223 [DOI] [PubMed] [Google Scholar]
131. Lewi L, Gratacos E, Ortibus E, et al. Pregnancy and infant outcome of 80 consecutive cord coagulations in complicated monochorionic multiple pregnancies. Am J Obstet Gynecol. 2006;194(3):782‐789. http://www.hlisd.org/LibraryDetail.aspx?LibraryID=3866 [DOI] [PubMed] [Google Scholar]
132. Moise KJKY, Johnson A, Nickeleit V, et al. Radiofrequency ablation for selective reduction in the complicated monochorionic gestation. Am J Obstet Gynecol. 2008;198(2):198.e1‐198.e5. 10.1016/j.ajog.2007.07.043 [DOI] [PubMed] [Google Scholar]
133. Nobili E, Paramasivam G, Kumar S. Outcome following selective fetal reduction in monochorionic and dichorionic twin pregnancies discordant for structural, chromosomal and genetic disorders. Aust N Z J Obstet Gynaecol. 2013;53(2):114‐118. 10.1111/ajo.12071 [DOI] [PubMed] [Google Scholar]
134. Paramasivam G, Wimalasundera R, Wiechec M, Zhang E, Saeed F, Kumar S. Radiofrequency ablation for selective reduction in complex monochorionic pregnancies. BJOG. 2010;117(10):1294‐1298. 10.1111/j.1471-0528.2010.02624.x [DOI] [PubMed] [Google Scholar]
135. Peng R, Xie HN, Lin MF, et al. Clinical outcomes after selective fetal reduction of complicated monochorionic twins with radiofrequency ablation and bipolar cord coagulation. Gynecol Obstet Invest. 2016;81(6):552‐558. 10.1159/000445291 [DOI] [PubMed] [Google Scholar]
136. Quintero RA, Romero R, Reich H, et al. In utero percutaneous umbilical cord ligation in the management of complicated monochorionic multiple gestations. Ultrasound Obstet Gynecol. 1996;8(1):16‐22. http://onlinelibrary.wiley.com/doi/10.1046/j.1469‐0705.1996.08010016.x/full [DOI] [PubMed] [Google Scholar]
137. Quintero RA, Chmait RH, Murakoshi T, et al. Surgical management of twin reversed arterial perfusion sequence. Am J Obstet Gynecol. 2006;194(4):982‐991. 10.1016/j.ajog.2005.10.195 [DOI] [PubMed] [Google Scholar]
138. Roman A, Papanna R, Johnson A, et al. Selective reduction in complicated monochorionic pregnancies: radiofrequency ablation vs. bipolar cord coagulation. Ultrasound Obstet Gynecol. 2010;36(1):37‐41. 10.1002/uog.7567 [DOI] [PubMed] [Google Scholar]
139. Schou KV, Jensen LN, Jørgensen C, Søgaard K, Tabor A, Sundberg K. Ultrasound‐guided bipolar umbilical cord occlusion in complicated monochorionic pregnancies: is there a learning curve. Fetal Diagn Ther. 2018;44(1):65‐71. 10.1159/000479104 [DOI] [PubMed] [Google Scholar]
140. Sugibayashi R, Ozawa K, Sumie M, Wada S, Ito Y, Sago H. Forty cases of twin reversed arterial perfusion sequence treated with radio frequency ablation using the multistep coagulation method: a single‐center experience. Prenat Diagn. 2016;36(5):437‐443. 10.1002/pd.4800 [DOI] [PubMed] [Google Scholar]
141. Takano M, Murata S, Fujiwara M, Hirata H, Nakata M. Experience of fetoscopic laser photocoagulation and cord transection for twin‐reversed arterial perfusion sequence. J Obstet Gynaecol Res. 2015;41(9):1326‐1329. 10.1111/jog.12720 [DOI] [PubMed] [Google Scholar]
142. Taylor MJO, Shalev E, Tanawattanacharoen S, et al. Ultrasound‐guided umbilical cord occlusion using bipolar diathermy for stage III/IV twin‐twin transfusion syndrome. Prenat Diagn. 2002;22(1):70‐76. [DOI] [PubMed] [Google Scholar]
143. Tsao KJ, Feldstein VA, Albanese CT, et al. Selective reduction of acardiac twin by radiofrequency ablation. Am J Obstet Gynecol. 2002;187(3):635‐640. 10.1067/mob.2002.125242 [DOI] [PubMed] [Google Scholar]
144. Zhang ZT, Yang T, Liu CX, Li N. Treatment of twin reversed arterial perfusion sequence with radiofrequency ablation and expectant management: a single center study in China. Eur J Obstet Gynecol Reprod Biol. 2018;225:9‐12. 10.1016/j.ejogrb.2018.03.046 [DOI] [PubMed] [Google Scholar]
145. Deprest J, Jani J, Gratacos E, et al. Fetal intervention for congenital diaphragmatic hernia: the European experience. Semin Perinatol. 2005;29(2):94‐103. [DOI] [PubMed] [Google Scholar]
146. Harrison M, Keller R, Hawgood S. A randomized trial of fetal endoscopic tracheal occlusion for severe fetal congential diaphragmatic hernia. N Engl J Med. 2003;349(20):1916‐1924. [DOI] [PubMed] [Google Scholar]
147. Jani J, Gratacós E, Greenough A, et al. Percutaneous fetal endoscopic tracheal occlusion (FETO) for severe left‐sided congenital diaphragmatic hernia. Clin Obstet Gynecol. 2005;48(4):910‐922. [DOI] [PubMed] [Google Scholar]
148. Jani JC, Nicolaides KH, Gratacós E, Vandecruys H, Deprest JA, Group FT . Fetal lung‐to‐head ratio in the prediction of survival in severe left‐sided diaphragmatic hernia treated by fetal endoscopic tracheal occlusion (FETO). Am J Obstet Gynecol. 2006;195(6):1646‐1650. [DOI] [PubMed] [Google Scholar]
149. Jani JC, Nicolaides KH, Gratacós E, et al. Severe diaphragmatic hernia treated by fetal endoscopic tracheal occlusion. Ultrasound Obstet Gynecol. 2009;34(3):304‐310. 10.1002/uog.6450 [DOI] [PubMed] [Google Scholar]
150. Jiménez JA, Eixarch E, DeKoninck P, et al. Balloon removal after fetoscopic endoluminal tracheal occlusion for congenital diaphragmatic hernia. Am J Obstet Gynecol. 2017;217(1):78 10.1016/j.ajog.2017.02.041 [DOI] [PubMed] [Google Scholar]
151. Kosinski P, Wielgos M. Foetoscopic endotracheal occlusion (FETO) for severe isolated left‐sided congenital diaphragmatic hernia: single center polish experience. J Matern Neonatal Med. 2018;31(19):2521‐2526. 10.1080/14767058.2017.1344969 [DOI] [PubMed] [Google Scholar]
152. Manrique S, Munar F, Andreu E, et al. Fetoscopic tracheal occlusion for the treatment of severe congenital diaphragmatic hernia: preliminary results. Rev Esp Anestesiol Reanim. 2008;55(7):407‐413. [DOI] [PubMed] [Google Scholar]
153. Peralta CFA, Sbragia L, Bennini JR, et al. Fetoscopic endotracheal occlusion for severe isolated diaphragmatic hernia: initial experience from a single clinic in Brazil. Fetal Diagn Ther. 2011;29(1):71‐77. 10.1159/000314617 [DOI] [PubMed] [Google Scholar]
154. Persico N, Fabietti I, Ciralli F, et al. Fetoscopic Endoluminal tracheal occlusion in fetuses with severe diaphragmatic hernia: a three‐year single‐center experience. Fetal Diagn Ther. 2017;41(3):215‐219. 10.1159/000448096 [DOI] [PubMed] [Google Scholar]
155. Ruano R, da Silva MM, Campos JADB, et al. Fetal pulmonary response after fetoscopic tracheal occlusion for severe isolated congenital diaphragmatic hernia. Obstet Gynecol. 2012;119(1):93‐101. 10.1097/AOG.0b013e31823d3aea [DOI] [PubMed] [Google Scholar]
156. Ruano R, Yoshisaki CT, da Silva MM, et al. A randomized controlled trial of fetal endoscopic tracheal occlusion versus postnatal management of severe isolated congenital diaphragmatic hernia. Ultrasound Obstet Gynecol. 2012;39(1):20‐27. 10.1002/uog.10142 [DOI] [PubMed] [Google Scholar]
157. Ruano R, Peiro JL, da Silva MM, et al. Early fetoscopic tracheal occlusion for extremely severe pulmonary hypoplasia in isolated congenital diaphragmatic hernia: preliminary results. Ultrasound Obstet Gynecol. 2013;42(1):70‐76. 10.1002/uog.12414 [DOI] [PubMed] [Google Scholar]
158. Arens C, Koch C, Veit M, et al. Anesthetic management for percutaneous minimally invasive fetoscopic surgery of spina bifida aperta: a retrospective, descriptive report of clinical experience. Anesth Analg. 2017;125(1):219‐222. [DOI] [PubMed] [Google Scholar]
159. Belfort MA, Whitehead WE, Shamshirsaz AA, et al. Fetoscopic open neural tube defect repair: development and refinement of a two‐port, carbon dioxide insufflation technique. Obstet Gynecol. 2017;129(4):734‐743. [DOI] [PubMed] [Google Scholar]
160. Degenhardt J, Schürg R, Winarno A, et al. Percutaneous minimal‐access fetoscopic surgery for spina bifida aperta. Part II: maternal management and outcome. Ultrasound Obstet Gynecol. 2014;44(5):525‐531. 10.1002/uog.13389 [DOI] [PubMed] [Google Scholar]
161. Kohn J, Rao V, Sellner A, et al. Management of labor and delivery after fetoscopic repair of an open neural tube defect. Obstet Gynecol. 2018;131(6):1062‐1068. [DOI] [PubMed] [Google Scholar]
162. Pedreira DAL, Zanon N, de Sá RAM, et al. Fetoscopic single‐layer repair of open spina bifida using a cellulose patch: preliminary clinical experience. J Matern Fetal Neonatal Med. 2014;27(16):1613‐1619. 10.3109/14767058.2013.871701 [DOI] [PubMed] [Google Scholar]
163. Pedreira DAL, Zanon N, Nishikuni K, et al. Endoscopic surgery for the antenatal treatment of myelomeningocele: the CECAM trial. Am J Obstet Gynecol. 2016;214(1):111 10.1016/j.ajog.2015.09.065 [DOI] [PubMed] [Google Scholar]
164. Verbeek RJ, Heep A, Maurits NM, et al. Fetal endoscopic myelomeningocele closure preserves segmental neurological function. Dev Med Child Neurol. 2012;54(1):15‐22. 10.1111/j.1469-8749.2011.04148.x [DOI] [PubMed] [Google Scholar]
165. Ziemann M, Fimmers R, Khaleeva A. Partial amniotic carbon dioxide insufflation (PACI) during minimally invasive fetoscopic interventions on fetuses with spina bifida aperta. Surg Endosc. 2018;32(7):3138‐3148. Epub ahead. 10.1007/s00464-018-6029-z [DOI] [PubMed] [Google Scholar]
166. Morris RK, Malin GL, Quinlan‐Jones E, et al. Percutaneous vesicoamniotic shunting versus conservative management for fetal lower urinary tract obstruction (PLUTO): a randomised trial. Lancet. 2013;382(9903):1496‐1506. 10.1016/S0140-6736(13)60992-7 [DOI] [PMC free article] [PubMed] [Google Scholar]
167. Ruano R, Duarte S, Bunduki V, Giron AM, Srougi M, Zugaib M. Fetal cystoscopy for severe lower urinary tract obstruction‐‐initial experience of a single center. Prenat Diagn. 2010;30(1):30‐39. 10.1002/pd.2418 [DOI] [PubMed] [Google Scholar]
168. Welsh A, Agarwal S, Kumar S, Smith RP, Fisk NM. Fetal cystoscopy in the management of fetal obstructive uropathy: experience in a single European Centre. Prenat Diagn. 2003;23(13):1033‐1041. 10.1002/pd.717 [DOI] [PubMed] [Google Scholar]
169. Cavalheiro S, Moron AF, Almodin CG, et al. Fetal hydrocephalus. Childs Nerv Syst. 2011;27(10):1575‐1583. 10.1007/s00381-011-1539-1 [DOI] [PubMed] [Google Scholar]
170. Mallmann MR, Graham V, Rösing B, et al. Thoracoamniotic shunting for fetal hydrothorax: predictors of intrauterine course and postnatal outcome. Fetal Diagn Ther. 2017;41(1):58‐65. 10.1159/000446110 [DOI] [PubMed] [Google Scholar]
171. Kohl T, Hering R, Van de Vondel P, et al. Analysis of the stepwise clinical introduction of experimental percutaneous fetoscopic surgical techniques for upcoming minimally invasive fetal cardiac interventions. Surg Endosc. 2006;20(7):1134‐1143. [DOI] [PubMed] [Google Scholar]
172. Kohl T, Tchatcheva K, Weinbach J, et al. Partial amniotic carbon dioxide insufflation (PACI) during minimally invasive fetoscopic surgery: early clinical experience in humans. Surg Endosc. 2010;24(2):432‐444. 10.1007/s00464-009-0579-z [DOI] [PubMed] [Google Scholar]
173. Nivatpumin P, Pangthipampai P, Jirativanont T, Dej‐Arkom S, Triyasunant N, Tempeetikul T. Anesthetic techniques and incidence of complications in fetoscopic surgery. J Med Assoc Thai. 2016;99(5):602‐610. [PubMed] [Google Scholar]
174. Peralta CFA, Sbragia L, Corrêa‐Silva EP, et al. Maternal complications following endoscopic surgeries in fetal medicine. Rev Bras Ginecol Obstet. 2010;32(6):260‐266. [PubMed] [Google Scholar]
175. Thom EA. Maternal reproductive outcomes after in‐utero repair of myelomeningocele. Am J Obstet Gynecol. 2016;214(1). [Google Scholar]
176. Wilson RD, Lemerand K, Johnson MP, et al. Reproductive outcomes in subsequent pregnancies after a pregnancy complicated by open maternal‐fetal surgery (1996‐2007). Am J Obstet Gynecol. 2010;203(3):209 10.1016/j.ajog.2010.03.029 [DOI] [PubMed] [Google Scholar]
177. Gregoir C, Engels AC, Gomez O, et al. Fertility, pregnancy and gynecological outcomes after fetoscopic surgery for congenital diaphragmatic hernia. Hum Reprod. 2016;31(9):2024‐2030. 10.1093/humrep/dew160 [DOI] [PubMed] [Google Scholar]
178. Le Lous M, Mediouni I, Chalouhi G, et al. Impact of laser therapy for twin‐to‐twin transfusion syndrome on subsequent pregnancy. Prenat Diagn. 2018;38(4):293‐297. 10.1002/pd.5227 [DOI] [PubMed] [Google Scholar]
179. Vergote S, Lewi L, Gheysen W, De Catte L, Devlieger R, Deprest J. Subsequent fertility, pregnancy, and gynecologic outcomes after fetoscopic laser therapy for twin‐twin transfusion syndrome compared with normal monochorionic twin gestations. Am J Obstet Gynecol. 2018;218(4):447.e1‐447.e7. 10.1016/j.ajog.2018.01.013 [DOI] [PubMed] [Google Scholar]
180. Mascarenhas MN, Flaxman SR, Boerma T, Vanderpoel S, Stevens GA. National, regional, and global trends in infertility prevalence since 1990: a systematic analysis of 277 health surveys. PLoS Med. 2012;9(12):1‐12. 10.1371/journal.pmed.1001356 [DOI] [PMC free article] [PubMed] [Google Scholar]
181. Wilcox A, Weinber C, O'Connor J, Baird D. Incidence of early pregnancy loss. N Engl J Med. 1988;319(4):189‐194. [DOI] [PubMed] [Google Scholar]
182. Andersen AN, Wohlfahrt J, Christens P, Olsen J, Melbye M, Nybo A. Maternal age and fetal loss: population based register linkage study. BMJ. 2000;320(June):1708‐1712. [DOI] [PMC free article] [PubMed] [Google Scholar]
183. Herbert D, Lucke J, Dobson A. Pregnancy losses in young Australian women. Findings from the Australian longitudinal study on Women's health. Womens Health Issues. 2009;19(1):21‐29. 10.1016/j.whi.2008.08.007 [DOI] [PubMed] [Google Scholar]
184. Blencowe H, Cousens S, Oestergaard MZ, et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet. 2012;379(9832):2162‐2172. 10.1016/S0140-6736(12)60820-4 [DOI] [PubMed] [Google Scholar]
185. Tanne JH. Preterm and low weight births rise again in the US. BMJ. 2017;3311:j3311 10.1136/bmj.j3311 [DOI] [PubMed] [Google Scholar]
186. National Institute for Health and Care Excellence . Preterm labour and birth. 2015. nice.org.uk/guidance/ng25. [PubMed]
187. Greene RA, Fitzpatrick C, Turner MJ. What are the maternal implications of a classical caesarean section? J Obstet Gynaecol. 1998;18(4):345‐347. 10.1080/01443619867083 [DOI] [PubMed] [Google Scholar]
188. Shavit C, Rollins M, Ferschl M. Maternal convulsion during high‐dose sevoflurane anaesthesia for open foetal surgery. Br J Anaesth. 2017;118(4):634‐635. [DOI] [PubMed] [Google Scholar]
189. Gratacós E, Deprest J. Current experience with fetoscopy and the Eurofoetus registry for fetoscopic procedures. Eur J Obstet Gynecol Reprod Biol. 2000;92(1):151‐159. [DOI] [PubMed] [Google Scholar]
190. NAFTNet Website . https://www.naftnet.org.
191. Bliton MJ. Parental hope confronting scientific uncertainty: a test of ethics in maternal‐fetal surgery for spina bifida. Clin Obstet Gynecol. 2005;48(3):595‐607. [DOI] [PubMed] [Google Scholar]
192. Fry JT, Frader JE. “We want to do everything”: how parents represent their experiences with maternal‐fetal surgery online. J Perinatol. 2018;38(3):226‐232. 10.1038/s41372-017-0040-4 [DOI] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Data S1: Search Strategy

Table S2: Classification of maternal surgical complications12

Table S3: Summary of risk of bias according to study type.

Table S4: Statistical heterogeneity according to outcome analysed.

Click here for additional data file.^{(113.8KB, docx)}

Data S2. Supporting information

Click here for additional data file.^{(244.4KB, docx)}

[pd5421-bib-0001] 1. Deprest JA, Flake AW, Gratacos E, et al. The making of fetal surgery. Prenat Diagn. 2010;30(7):653‐667. 10.1002/pd.2571 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0002] 2. Jancelewicz T, Harrison MR. A history of fetal surgery. Clin Perinatol. 2009;36(2):227 10.1016/j.clp.2009.03.007‐236 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0003] 3. Deprest JA, Done E, Van Mieghem T, Gucciardo L. Fetal surgery for anesthesiologists. Curr Opin Anaesthesiol. 2008;21(3):298‐307. 10.1097/ACO.0b013e3282ff8607 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0004] 4. Farrell JA, Albanese CT, Jennings RW, Kilpatrick SJ, Bratton BJ, Harrison MR. Maternal fertility is not affected by fetal surgery. Fetal Diagn Ther. 1999;14(3):190‐192. [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0005] 5. Moon‐Grady A, Baschat A, Cass D. Fetal treatment 2017: the evolution of fetal therapy centers—a joint opinion from the international fetal medicine and surgical society (IFMSS) and the north American fetal therapy network (NAFTNet). Fetal Diagn Ther. 2017;42(4):241‐248. [DOI] [PMC free article] [PubMed] [Google Scholar]

[pd5421-bib-0006] 6. Golombeck K, Ball RH, Lee H, et al. Maternal morbidity after maternal‐fetal surgery. Am J Obstet Gynecol. 2006;194(3):834‐839. [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0007] 7. Merz W, Tchatcheva K, Gembruch U, Kohl T. Maternal complications of fetoscopic laser photocoagulation (FLP) for treatment of twin‐twin transfusion syndrome (TTTS). J Perinat Med. 2010;38(4):439‐443. 10.1515/JPM.2010.061 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0008] 8. Moher D, Liberati A, Tetzlaff J, Altman D, The PRISMA Group . Preferred reporting items for systematic reviews and meta‐analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. [DOI] [PMC free article] [PubMed] [Google Scholar]

[pd5421-bib-0009] 9. Carey TS, Boden SD. A critical guide to case series reports. Spine (Phila Pa 1976). 2003;28(15):1631‐1634. 10.1097/01.BRS.0000083174.84050.E5 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0010] 10. The Royal College of Obstetricians and Gynaecologists . Antepartum Haemorrhage Green‐top Guideline No. 63. 2011;(63). https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_63.pdf.

[pd5421-bib-0011] 11. Gulmezoglu AM, Souza JP, Mathai M. WHO recommendations for the prevention and treatment of postpartum haemorrhage. 2012. 10.1016/j.ijgo.2013.06.024. [DOI]

[pd5421-bib-0012] 12. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205‐213. 10.1097/01.sla.0000133083.54934.ae [DOI] [PMC free article] [PubMed] [Google Scholar]

[pd5421-bib-0013] 13. Higgins J, Green S. Assessing risk of bias in included studies. Cochrane Handb Syst Rev Interv 2008:187–241.

[pd5421-bib-0014] 14. Wells G, Shea B, O'Connell D, Peterson J, Welcho V, Losos M. The Newcastle‐Ottawa scale (NOS) for assessing the quality of nonrandomized studies in meta‐analyses. Ottawa Heal Res Inst 2011. http://www.ohri.ca/programs/clinical_epidemiology/nos_manual.pdf

[pd5421-bib-0015] 15. National Institutes of Health: study quality assessment tools. www.nhlbi.nih.gov/health‐topics/study‐quality‐assessment‐tools. Published 2014.

[pd5421-bib-0016] 16. Barthod G, Teissier N, Bellarbi N, et al. Fetal airway management on placental support: limitations and ethical considerations in seven cases. J Obstet Gynaecol. 2013;33(8):787‐794. 10.3109/01443615.2013.823924 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0017] 17. Cass DL, Olutoye OO, Cassady CI, et al. EXIT‐to‐resection for fetuses with large lung masses and persistent mediastinal compression near birth. J Pediatr Surg. 2013;48(1):138‐144. 10.1016/j.jpedsurg.2012.10.067 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0018] 18. Chen XY, Yang JX, Zhang HY, et al. Ex utero intrapartum treatment for giant congenital omphalocele. World J Pediatr. 2018;(0123456789);14(4):1‐5. 10.1007/s12519-018-0129-7 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0019] 19. Dahlgren G, Törnberg DC, Pregner K, Irestedt L. Four cases of the ex utero intrapartum treatment (EXIT) procedure: anesthetic implications. Int J Obstet Anesth. 2004;13(3):178‐182. [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0020] 20. Flake AW, Crombleholme TM, Johnson MP, Howell LJ, Adzick NS. Treatment of severe congenital diaphragmatic hernia by fetal tracheal occlusion: clinical experience with fifteen cases. Am J Obstet Gynecol. 2000;183(5):1059‐1066. [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0021] 21. George RB, Melnick AH, Rose EC, Habib AS. Case series: combined spinal epidural anesthesia for cesarean delivery and ex utero intrapartum treatment procedure. Can J Anaesth. 2007;54(3):218‐222. [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0022] 22. Hedrick HL. Ex utero intrapartum therapy. Semin Pediatr Surg. 2003;12(3):190‐195. [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0023] 23. Hedrick HL, Flake AW, Crombleholme TM, et al. The ex utero intrapartum therapy procedure for high‐risk fetal lung lesions. J Pediatr Surg. 2005;40(6):1038‐1044. 10.1016/j.jpedsurg.2005.03.024 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0024] 24. Kern C, Ange M, Morales PB, Pfister RE. Ex utero intrapartum treatment (EXIT), a resuscitation option for intra‐thoracic foetal pathologies. Swiss Med Wkly. 2007;137(19–20):279‐285. [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0025] 25. Kornacki J, Szydłowski J, Skrzypczak J, et al. Use of ex utero intrapartum treatment procedure in fetal neck and high airway anomalies—report of four clinical cases. J Matern Neonatal Med. 2017;0(0);32(5):1‐5. 10.1080/14767058.2017.1390740 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0026] 26. Kunisaki SM, Barnewolt CE, Estroff JA, et al. Ex utero intrapartum treatment with extracorporeal membrane oxygenation for severe congenital diaphragmatic hernia. J Pediatr Surg. 2007;42(1):98. [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0027] 27. Laje P, Johnson MP, Howell LJ, et al. Ex utero intrapartum treatment in the management of giant cervical teratomas. J Pediatr Surg. 2012;47(6):1208‐1216. 10.1016/j.jpedsurg.2012.03.027 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0028] 28. Laje P, Howell LJ, Johnson MP, Hedrick HL, Flake AW, Adzick NS. Perinatal management of congenital oropharyngeal tumors: the ex utero intrapartum treatment (EXIT) approach. J Pediatr Surg. 2013;48(10):2005‐2010. 10.1016/j.jpedsurg.2013.02.031 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0029] 29. Laje P, Peranteau WH, Hedrick HL, et al. Ex utero intrapartum treatment (EXIT) in the management of cervical lymphatic malformation. J Pediatr Surg. 2015;50(2):311‐314. 10.1016/j.jpedsurg.2014.11.024 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0030] 30. Lazar DA, Olutoye OO, Moise KJ, et al. Ex‐utero intrapartum treatment procedure for giant neck masses‐‐fetal and maternal outcomes. J Pediatr Surg. 2011;46(5):817‐822. 10.1016/j.jpedsurg.2011.02.006 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0031] 31. Noah MMS, Norton ME, Sandberg P, Esakoff T, Farrell J, Albanese CT. Short‐term maternal outcomes that are associated with the EXIT procedure, as compared with cesarean delivery. Am J Obstet Gynecol. 2002;186(4):773‐777. [PubMed] [Google Scholar]

[pd5421-bib-0032] 32. Pellicer M, Pumarola F, Peiró JL, et al. EXIT procedure in the management of severe foetal airway obstruction. The paediatric otolaryngologist's perspective. Acta Otorrinolaringol Esp. 2007;58(10):487‐490. [PubMed] [Google Scholar]

[pd5421-bib-0033] 33. Stoffan AP, Wilson JM, Jennings RW, Wilkins‐Haug LE, Buchmiller TL. Does the ex utero intrapartum treatment to extracorporeal membrane oxygenation procedure change outcomes for high‐risk patients with congenital diaphragmatic hernia? J Pediatr Surg. 2012;47(6):1053‐1057. 10.1016/j.jpedsurg.2012.03.004 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0034] 34. Tuncay Ozgunen F, Kucukgoz Gulec U, Evruke I, Agcabay C, Kadayifci T, Ozcan K. Fetal orofarengeal tumorler ve EXIT islemine dogum hekimi acisindan bakis [the point of view by obstetricians to fetal oropharengal tumors and EXIT procedure: case report]. Turkiye Klin Jinekoloji Obstet. 2010;20(4):247‐251. [Google Scholar]

[pd5421-bib-0035] 35. Zamora IJ, Ethun CG, Evans LM, et al. Maternal morbidity and reproductive outcomes related to fetal surgery. J Pediatr Surg. 2013;48(5):951‐955. 10.1016/j.jpedsurg.2013.02.010 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0036] 36. Bennett KA, Carroll MA, Shannon CN, et al. Reducing perinatal complications and preterm delivery for patients undergoing in utero closure of fetal myelomeningocele: further modifications to the multidisciplinary surgical technique. J Neurosurg Pediatr. 2014;14(1):108‐114. 10.3171/2014.3.PEDS13266 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0037] 37. Botelho R, Imada V, Rodrigues da Costa K, Watanabe L, Rossi RJ. Fetal myelomeningocele repair through a mini‐hysterotomy. Fetal Diagn Ther. 2017;42(1):28‐34. [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0038] 38. Bruner JP, Tulipan N, Paschall RL, et al. Fetal surgery for myelomeningocele and the incidence of shunt‐dependent hydrocephalus. JAMA. 1999;282(19):1819‐1825. [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0039] 39. Bruner JP, Tulipan NB, Richards WO, Walsh WF, Boehm FH, Vrabcak EK. In utero repair of myelomeningocele: a comparison of endoscopy and hysterotomy. Fetal Diagn Ther. 2000;15(2):83‐88. [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0040] 40. Farmer DL, von Koch CS, Peacock WJ, et al. In utero repair of myelomeningocele: experimental pathophysiology, initial clinical experience, and outcomes. Arch Surg. 2003;138(8):872‐878. http://www.hlisd.org/LibraryDetail.aspx?LibraryID=3866 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0041] 41. Friszer S, Dhombres F, Di Rocco F, et al. Preliminary results from the French study on prenatal repair for fetal myelomeningoceles (the PRIUM study). J Gynecol Obstet Biol Reprod. 2016;45(7):738‐744. 10.1016/j.jgyn.2015.09.002 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0042] 42. Johnson MP, Bennett KA, Rand L, et al. The management of myelomeningocele study: obstetrical outcomes and risk factors for obstetrical complications following prenatal surgery. Am J Obstet Gynecol. 2016;215(6):778 10.1016/j.ajog.2016.07.052 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pd5421-bib-0043] 43. Marenco ML, Márquez J, Ontanilla A, et al. Intrauterine myelomeningocele repair: experience of the fetal medicine and therapy program of the Virgen de Rocío University hospital. Rev Esp Anestesiol Reanim. 2013;60(1):47‐53. 10.1016/j.redar.2012.07.011 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0044] 44. Moldenhauer JS, Soni S, Rintoul NE, et al. Fetal myelomeningocele repair: the post‐MOMS experience at the Children's Hospital of Philadelphia. Fetal Diagn Ther. 2015;37(3):235‐240. 10.1159/000365353 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0045] 45. Moron A, Barbosa M, Milani H, et al. Perinatal outcomes after open fetal surgery for myelomeningocele repair: a retrospective cohort study. BJOG. 2018; 125(10):1280‐1286. [Epub ahea. 10.1111/1471-0528.15312 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pd5421-bib-0046] 46. Ochsenbein‐Kölble N, Krähenmann F, Hüsler M, et al. Tocolysis for in utero surgery: atosiban performs distinctly better than magnesium sulfate. Fetal Diagn Ther. 2017. 10.1159/000478261;44(1):59‐64. [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0047] 47. Sinskey JL, Rollins MD, Whitlock E, et al. Incidence and management of umbilical artery flow abnormalities during open fetal surgery. Fetal Diagn Ther. 2017. 10.1159/000477963;43(4):274‐283. [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0048] 48. Soni S, Moldenhauer JS, Spinner SS, et al. Chorioamniotic membrane separation and preterm premature rupture of membranes complicating in utero myelomeningocele repair. Am J Obstet Gynecol. 2016;214(5):647 10.1016/j.ajog.2015.12.003 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0049] 49. Zamlynski J, Olejek A, Tomasz K. Comparison of prenatal and postnatal treatments of spina bifida in Poland—a non‐randomized, single‐center study. J Matern Neonatal Med. 2014;27(14):1409‐1417. [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0050] 50. Harrison MR, Langer JC, Adzick NS, et al. Correction of congenital diaphragmatic hernia in utero, V. Initial clinical experience. J Pediatr Surg. 1990;25(1):47‐57. [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0051] 51. Harrison MR, Adzick NS, Flake AW, et al. Correction of congenital diaphragmatic hernia in utero: VI. Hard‐earned lessons. J Pediatr Surg. 1993;28(10):1411‐1418. [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0052] 52. Harrison MR, Mychaliska GB, Albanese CT, et al. Correction of congenital diaphragmatic hernia in utero IX: fetuses with poor prognosis (liver herniation and low lung‐to‐head ratio) can be saved by fetoscopic temporary tracheal occlusion. J Pediatr Surg. 1998;33(7):1017‐1023. [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0053] 53. Adzick NS, Flake AW, Crombleholme TM. Management of congenital lung lesions. Semin Pediatr Surg. 2003;12(1):10‐16. [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0054] 54. Hedrick HL, Flake AW, Crombleholme TM, et al. Sacrococcygeal teratoma: prenatal assessment, fetal intervention, and outcome. J Pediatr Surg. 2004;39(3):430‐438. [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0055] 55. Longaker MT, Golbus MS, Filly RA, Rosen MA, Chang SW, Harrison MR. Maternal outcome after open fetal surgery. A review of the first 17 human cases. JAMA. 1991;265(6):737‐741. http://www.hlisd.org/LibraryDetail.aspx?LibraryID=3866 [PubMed] [Google Scholar]

[pd5421-bib-0056] 56. Aboudiab MS, Chon AH, Korst LM, Llanes A, Ouzounian JG, Chmait RH. Management of twin–twin transfusion syndrome with an extremely short cervix. J Obstet Gynaecol. 2018;38(3):359‐362. 10.1080/01443615.2017.1330324 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0057] 57. Baschat AA, Barber J, Pedersen N, Turan OM, Harman CR. Outcome after fetoscopic selective laser ablation of placental anastomoses vs equatorial laser dichorionization for the treatment of twin‐to‐twin transfusion syndrome. Am J Obstet Gynecol. 2013;209(3):234 10.1016/j.ajog.2013.05.034 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0058] 58. Chalouhi GE, Quibel T, Benzina N, Bernard J‐P, Essaoui M, Ville Y. Outcome of triplet pregnancies managed for twin‐to‐twin transfusion syndrome: A single center experience. J Gynecol Obstet Biol Reprod. 2016;45(8):929‐935. 10.1016/j.jgyn.2015.08.006 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0059] 59. Chang J, Tracy TF, Carr SR, Sorrells DL, Luks FI. Port insertion and removal techniques to minimize premature rupture of the membranes in endoscopic fetal surgery. J Pediatr Surg. 2006;41(5):905‐909. [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0060] 60. Chang Y‐L, Chao A‐S, Chang S‐D, et al. Outcome of twin‐twin transfusion syndrome treated by laser therapy in Taiwan's single center: role of Quintero staging system. Taiwan J Obstet Gynecol. 2016;55(5):700‐704. 10.1016/j.tjog.2015.05.006 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0061] 61. Chmait RH, Korst LM, Llanes A, Mullin P, Lee RH, Ouzounian JG. Perioperative characteristics associated with preterm birth in twin‐twin transfusion syndrome treated by laser surgery. Am J Obstet Gynecol. 2013;209(3):264 10.1016/j.ajog.2013.05.025 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0062] 62. Chmait RH, Kontopoulos EV, Chon AH, Korst LM, Llanes A, Quintero RA. Amniopatch treatment of iatrogenic preterm premature rupture of membranes (iPPROM) after fetoscopic laser surgery for twin–twin transfusion syndrome. J Matern Neonatal Med. 2017;30(11):1349‐1354. 10.1080/14767058.2016.1214123 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0063] 63. Crombleholme TM, Shera D, Lee H, et al. A prospective, randomized, multicenter trial of amnioreduction vs selective fetoscopic laser photocoagulation for the treatment of severe twin‐twin transfusion syndrome. Am J Obstet Gynecol. 2007;197(4):396. [DOI] [PMC free article] [PubMed] [Google Scholar]

[pd5421-bib-0064] 64. De Lia JE, Kuhlmann RS, Harstad TW, Cruikshank DP. Fetoscopic laser ablation of placental vessels in severe previable twin‐twin transfusion syndrome. Am J Obstet Gynecol. 1995;172(4):1202. [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0065] 65. De Lia JE, Kuhlmann RS, Lopez KP. Treating previable twin‐twin transfusion syndrome with fetoscopic laser surgery: outcomes following the learning curve. J Perinat Med. 1999;27(1):61‐67. [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0066] 66. De Lia JE, Worthington D, Carr MH, Graupe MH, Melone PJ. Placental laser surgery for severe previable feto‐fetal transfusion syndrome in triplet gestation. Am J Perinatol. 2009;26(8):559‐564. 10.1055/s-0029-1220789 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0067] 67. Deprest JA, Van Schoubroeck D, Van Ballaer PP, Flageole H, Van Assche FA, Vandenberghe K. Alternative technique for Nd: YAG laser coagulation in twin‐to‐twin transfusion syndrome with anterior placenta. Ultrasound Obstet Gynecol. 1998;11(5):347‐352. [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0068] 68. Draga E, Janiak K, Bielak A, et al. Fetal therapy‐laser therapy of twin‐to‐twin transfusion syndrome/TTTS/. Polish Gynaecol. 2016;87(02):104‐110. 10.17772/gp/61328 [DOI] [Google Scholar]

[pd5421-bib-0069] 69. Duron VD, Watson‐Smith D, Benzuly SE, et al. Maternal and fetal safety of fluid‐restrictive general anesthesia for endoscopic fetal surgery in monochorionic twin gestations. J Clin Anesth. 2014;26(3):184‐190. 10.1016/j.jclinane.2013.10.010 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0070] 70. Ek S, Kublickas M, Bui T‐H, et al. Establishing a national program for fetoscopic guided laser occlusion for twin‐to‐twin transfusion syndrome in Sweden. Acta Obstet Gynecol Scand. 2012;91(10):1196‐1200. 10.1111/j.1600-0412.2012.01447.x [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0071] 71. Habli M, Bombrys A, Lewis D, et al. Incidence of complications in twin‐twin transfusion syndrome after selective fetoscopic laser photocoagulation: a single‐center experience. Am J Obstet Gynecol. 2009;201(4):417 10.1016/j.ajog.2009.07.046 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0072] 72. Has R, Kalelioglu I, Corbacioglu Esmer A, et al. Stage‐related outcome after fetoscopic laser ablation in twin‐to‐twin transfusion syndrome. Fetal Diagn Ther. 2014;36(4):287‐292. 10.1159/000362385 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0073] 73. Hecher K, Diehl W, Zikulnig L, Vetter M, Hackelöer BJ. Endoscopic laser coagulation of placental anastomoses in 200 pregnancies with severe mid‐trimester twin‐to‐twin transfusion syndrome. Eur J Obstet Gynecol Reprod Biol. 2000;92(1):135‐139. [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0074] 74. Hernández‐Andrade E, Guzmán‐Huerta M, Benavides‐Serralde JA, et al. Laser ablation of the placental vascular anastomoses for the treatment of twin‐to‐twin transfusion syndrome. Rev Invest Clin. 2011;63(1):46‐52. [PubMed] [Google Scholar]

[pd5421-bib-0075] 75. Huber A, Baschat AA, Bregenzer T, et al. Laser coagulation of placental anastomoses with a 30 degrees fetoscope in severe mid‐trimester twin‐twin transfusion syndrome with anterior placenta. Ultrasound Obstet Gynecol. 2008;31(4):412‐416. 10.1002/uog.5283 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0076] 76. Ishii K, Nakata M, Wada S, Hayashi S, Murakoshi T, Sago H. Perinatal outcome after laser surgery for triplet gestations with feto‐fetal transfusion syndrome. Prenat Diagn. 2014;34(8):734‐738. 10.1002/pd.4357 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0077] 77. Ishii K, Nakata M, Wada S, Murakoshi T, Sago H. Feasibility and preliminary outcomes of fetoscopic laser photocoagulation for monochorionic twin gestation with selective intrauterine growth restriction accompanied by severe oligohydramnios. J Obstet Gynaecol Res. 2015;41(11):1732‐1737. 10.1111/jog.12827 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0078] 78. Lanna MM, Faiola S, Consonni D, Rustico MA. Increased risk of placental abruption after Solomon laser treatment of twin‐twin transfusion syndrome. Placenta. 2017;53:54‐56. 10.1016/j.placenta.2017.03.018 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0079] 79. Lecointre L, Sananès N, Weingertner AS, et al. Photocoagulation laser par fœtoscopie pour syndrome transfuseur‐transfusé: analyse d'une série consécutive unicentrique de 200 cas. J Gynecol Obstet Hum Reprod. 2017;46(2):175‐181. 10.1016/j.jogoh.2016.10.004 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0080] 80. Malshe A, Snowise S, Mann LK, et al. Preterm delivery after fetoscopic laser surgery for twin‐twin transfusion syndrome: etiology and risk factors. Ultrasound Obstet Gynecol. 2017;49(5):612‐616. 10.1002/uog.15972 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0081] 81. Martínez JM, Eixarch E, Crispi F, Puerto B, Gratacós E. Tratamiento por fetoscopia de la transfusión feto‐fetal: resultados en 500 casos consecutivos. Diagnostico Prenat. 2012;23(3):102‐108. 10.1016/j.diapre.2012.06.010 [DOI] [Google Scholar]

[pd5421-bib-0082] 82. Middeldorp JM, Sueters M, Lopriore E, et al. Fetoscopic laser surgery in 100 pregnancies with severe twin‐to‐twin transfusion syndrome in the Netherlands. Fetal Diagn Ther. 2007;22(3):190‐194. [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0083] 83. Miyadahira M, Brizot M, Carvalho M, et al. Type II and III selective fetal growth restriction: perinatal outcomes of expectant management and laser ablation of placental vessels. Clinics. 2018;73:1‐5. 10.6061/clinics/2018/e210 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pd5421-bib-0084] 84. Molina García FS, Zaragoza García E, Carrillo Badillo MP, Fernández de Santos AG, Calpena García A, Montoya Ventoso F. Implementación de la terapia láser endoscópica para las complicaciones de gestaciones gemelares monocoriales. Progresos en Obstet y Ginecol. 2009;52(6):313‐319. 10.1016/S0304-5013(09)71466-9 [DOI] [Google Scholar]

[pd5421-bib-0085] 85. Morris RK, Selman TJ, Harbidge A, Martin WI, Kilby MD. Fetoscopic laser coagulation for severe twin‐to‐twin transfusion syndrome: factors influencing perinatal outcome, learning curve of the procedure and lessons for new centres. BJOG. 2010;117(11):1350‐1357. 10.1111/j.1471-0528.2010.02680.x [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0086] 86. Müllers SM, McAuliffe FM, Kent E, et al. Outcome following selective fetoscopic laser ablation for twin to twin transfusion syndrome: an 8 year national collaborative experience. Eur J Obstet Gynecol Reprod Biol. 2015;191:125‐129. 10.1016/j.ejogrb.2015.05.019 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0087] 87. Nakata M, Ishii K, Sumie M, et al. A prospective pilot study of fetoscopic laser surgery for twin‐to‐twin transfusion syndrome between 26 and 27 weeks of gestation. Taiwan J Obstet Gynecol. 2016;55(4):512‐514. 10.1016/j.tjog.2016.06.002 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0088] 88. Nguyen HK, Cheng YW, Lee H, et al. 446: recent experience with twin‐twin transfusion syndrome: 2005‐2011. Am J Obstet Gynecol. 2012;206(1):S205 10.1016/j.ajog.2011.10.464 [DOI] [Google Scholar]

[pd5421-bib-0089] 89. Ozawa K, Sugibayashi R, Wada S, et al. Fetoscopic laser photocoagulation for amniotic fluid discordance bordering on twin–twin transfusion syndrome: feasibility, perinatal and long‐term outcomes. J Obstet Gynaecol Res. 2017;43(8):1256‐1262. 10.1111/jog.13349 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0090] 90. Papanna R, Johnson A, Ivey RT, Olutoye OO, Cass D, Moise KJ. Laparoscopy‐assisted fetoscopy for laser surgery in twin‐twin transfusion syndrome with anterior placentation. Ultrasound Obstet Gynecol. 2010;35(1):65‐70. 10.1002/uog.7495 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0091] 91. Papanna R, Habli M, Baschat AA, et al. Cerclage for cervical shortening at fetoscopic laser photocoagulation in twin‐twin transfusion syndrome. Am J Obstet Gynecol. 2012;206(5):425 10.1016/j.ajog.2012.02.022 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0092] 92. Peeters SHP, Stolk TT, Slaghekke F, et al. Iatrogenic perforation of intertwin membrane after laser surgery for twin‐to‐twin transfusion syndrome. Ultrasound Obstet Gynecol. 2014;44(5):550‐556. 10.1002/uog.13445 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0093] 93. Persico N, Fabietti I, D'Ambrosi F, Riccardi M, Boito S, Fedele L. Postnatal survival after endoscopic equatorial laser for the treatment of twin‐to‐twin transfusion syndrome. Am J Obstet Gynecol. 2016;214(4):533 10.1016/j.ajog.2015.10.020 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0094] 94. Quintero RA, Comas C, Bornick PW, Allen MH, Kruger M. Selective versus non‐selective laser photocoagulation of placental vessels in twin‐to‐twin transfusion syndrome. Ultrasound Obstet Gynecol. 2000;16(3):230‐236. http://onlinelibrary.wiley.com/doi/10.1046/j.1469‐0705.2000.00265.x/full [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0095] 95. Quintero RA, Bornick PW, Allen MH, Johson PK. Selective laser photocoagulation of communicating vessels in severe twin‐twin transfusion syndrome in women with an anterior placenta. Obstet Gynecol. 2001;97(3):477‐481. [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0096] 96. Rossi AC, Kaufman MA, Bornick PW, Quintero RA. General vs local anesthesia for the percutaneous laser treatment of twin‐twin transfusion syndrome. Am J Obstet Gynecol. 2008;199(2):137 10.1016/j.ajog.2007.12.008 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0097] 97. Ruano R, de Lourdes Brizot M, Liao AW, Zugaib M. Selective fetoscopic laser photocoagulation of superficial placental anastomoses for the treatment of severe twin‐twin transfusion syndrome. Clinics (Sao Paulo). 2009;64(2):91‐96. http://europepmc.org/search?query=(DOI:%2210.1590/S1807‐59322009000200005%22) [DOI] [PMC free article] [PubMed] [Google Scholar]

[pd5421-bib-0098] 98. Rüegg L, Hüsler M, Krähenmann F, Natalucci G, Zimmermann R, Ochsenbein‐Kölble N. Outcome after fetoscopic laser coagulation in twin–twin transfusion syndrome—is the survival rate of at least one child at 6 months of age dependent on preoperative cervical length and preterm prelabour rupture of fetal membranes? J Matern Neonatal Med. 2018;0(0);1‐9. 10.1080/14767058.2018.1506441 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0099] 99. Rustico MA, Lanna MM, Faiola S, et al. Fetal and maternal complications after selective fetoscopic laser surgery for twin‐to‐twin transfusion syndrome: a single‐center experience. Fetal Diagn Ther. 2012;31(3):170‐178. 10.1159/000336227 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0100] 100. Said S, Flood K, Breathnach F, et al. Fetoscopic laser treatment of twin‐to‐twintransfusion syndrome (TTTS). Ir Med J. 2008;101(6):191‐193. [PubMed] [Google Scholar]

[pd5421-bib-0101] 101. Senat M‐V, Deprest J, Boulvain M, Paupe A, Winer N, Ville Y. Endoscopic laser surgery versus serial amnioreduction for severe twin‐to‐twin transfusion syndrome. N Engl J Med. 2004;351(2):136‐144. [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0102] 102. Sepulveda W, Wong AE, Dezerega V, Devoto JC, Alcalde JL. Endoscopic laser surgery in severe second‐trimester twin‐twin transfusion syndrome: a three‐year experience from a Latin American center. Prenat Diagn. 2007;27(11):1033‐1038. [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0103] 103. Shamshirsaz AA, Javadian P, Ruano R, et al. Comparison between laparoscopically assisted and standard fetoscopic laser ablation in patients with anterior and posterior placentation in twin‐twin transfusion syndrome: a single center study. Prenat Diagn. 2015;35(4):376‐381. 10.1002/pd.4552 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0104] 104. Slaghekke F, Lopriore E, Lewi L, et al. Fetoscopic laser coagulation of the vascular equator versus selective coagulation for twin‐to‐twin transfusion syndrome: an open‐label randomised controlled trial. Lancet. 2014;383(9935):2144‐2151. 10.1016/S0140-6736(13)62419-8 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0105] 105. Taniguchi K, Sumie M, Sugibayashi R, Wada S, Matsuoka K, Sago H. Twin anemia‐polycythemia sequence after laser surgery for twin‐twin transfusion syndrome and maternal morbidity. Fetal Diagn Ther. 2015;37(2):148‐153. 10.1159/000365812 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0106] 106. Tchirikov M, Oshovskyy V, Steetskamp J, Falkert A, Huber G, Entezami M. Neonatal outcome using ultrathin fetoscope for laser coagulation in twin‐to‐twin‐transfusion syndrome. J Perinat Med. 2011;39(6):725‐730. 10.1515/JPM.2011.091 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0107] 107. Teoh M, Walker S, Cole S, Edwards A. “A problem shared is a problem halved”: success of a statewide collaborative approach to fetal therapy. Outcomes of fetoscopic laser photocoagulation for twin‐twin transfusion syndrome in Victoria. Aust N Z J Obstet Gynaecol. 2013;53(2):108‐113. 10.1111/ajo.12062 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0108] 108. Thia E, Thain S, Yeo G. Fetoscopic laser photocoagulation in twin‐to‐twin transfusion syndrome: experience from a single institution. Singapore Med J. 2017;58(6):321‐326. 10.11622/smedj.2016067 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pd5421-bib-0109] 109. Ville Y, Van Peborgh P, Gagnon A, Frydman R, Fernandez H. Surgical treatment of twin‐to‐twin transfusion syndrome: coagulation of anastomoses with a Nd:YAG laser, under endosonographic control. Forty four cases. J Gynecol Obstet Biol Reprod. 1997;26(2):175‐181. [PubMed] [Google Scholar]

[pd5421-bib-0110] 110. Ville Y, Hecher K, Gagnon A, Sebire N, Hyett J, Nicolaides K. Endoscopic laser coagulation in the management of severe twin‐to‐twin transfusion syndrome. Br J Obstet Gynaecol. 1998;105(4):446‐453. [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0111] 111. Weingertner A‐S, Kohler A, Mager C, et al. Fetoscopic laser coagulation in 100 consecutive monochorionic pregnancies with severe twin‐to‐twin transfusion syndrome. J Gynecol Obstet Biol Reprod. 2011;40(5):444‐451. 10.1016/j.jgyn.2011.04.001 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0112] 112. Wilson I, Henry A, Hinch E, et al. Audit of immediate outcomes for MCDA twins following laser therapy for twin‐twin transfusion syndrome at the NSW fetal therapy centre. Aust N Z J Obstet Gynaecol. 2016;56(3):289‐294. 10.1111/ajo.12464 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0113] 113. Yamamoto M, El Murr L, Robyr R, Leleu F, Takahashi Y, Ville Y. Incidence and impact of perioperative complications in 175 fetoscopy‐guided laser coagulations of chorionic plate anastomoses in fetofetal transfusion syndrome before 26 weeks of gestation. Am J Obstet Gynecol. 2005;193(3):1110‐1116. [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0114] 114. Yang X, Leung TY, Ngan Kee WD, Chen M, Chan LW, Lau TK. Fetoscopic laser photocoagulation in the management of twin‐twin transfusion syndrome: local experience from Hong Kong. Hong Kong Med J. 2010;16(4):275‐281. [PubMed] [Google Scholar]

[pd5421-bib-0115] 115. Zaretsky MV, Tong SH, Lagueux M, et al. North American fetal therapy network: indications for delivery following laser ablation for twin‐twin transfusion syndrome. Am J Obstet Gynecol. 2018;218(1):S316‐S316. 10.1016/j.ajog.2017.11.055 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pd5421-bib-0116] 116. Zhao D, Cohen D, Middeldorp JM, et al. Histologic chorioamnionitis and funisitis after laser surgery for twin‐twin transfusion syndrome. Obstet Gynecol. 2016;128(2):304‐312. 10.1097/AOG.0000000000001469 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0117] 117. Bebbington MW, Danzer E, Moldenhauer J, Khalek N, Johnson MP. Radiofrequency ablation vs bipolar umbilical cord coagulation in the management of complicated monochorionic pregnancies. Ultrasound Obstet Gynecol. 2012;40(3):319‐324. 10.1002/uog.11122 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0118] 118. Berg C, Holst D, Mallmann MR, Gottschalk I, Gembruch U, Geipel A. Early vs late intervention in twin reversed arterial perfusion sequence. Ultrasound Obstet Gynecol. 2014;43(1):60‐64. 10.1002/uog.12578 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0119] 119. Delabaere A, Favre N, Velemir L, et al. Suivi pédiatrique de 30 grossesses gémellaires monochoriales consécutives traitées par fœticide sélectif. Gynecol Obstet Fertil. 2013;41(2):85‐89. 10.1016/j.gyobfe.2012.12.007 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0120] 120. Deprest JA, Audibert F, Van Schoubroeck D, Hecher K, Mahieu‐Caputo D. Bipolar coagulation of the umbilical cord in complicated monochorionic twin pregnancy. Am J Obstet Gynecol. 2000;182(2):340‐345. 10.1016/S0002-9378(00)70221-3 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0121] 121. Gallot D, Laurichesse H, Lemery D. Selective feticide in monochorionic twin pregnancies by ultrasound‐guided umbilical cord occlusion. Ultrasound Obstet Gynecol. 2003;22(5):484‐488. 10.1002/uog.917 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0122] 122. Gouverneur M, Klumper F, Loproire E, Vandenbussche F, Oepkes D. Selectieve foeticide door navelstrengcoagulatie bij afwijkende monochoriale meerlingen. Ned Tijdschr Geneeskd. 2009;153(19):906‐911. [PubMed] [Google Scholar]

[pd5421-bib-0123] 123. Gül A, Güngördük K, Yildirim G, et al. Bipolar cord coagulation in monochorionic twins discordant for major fetal anomalies. J Turkish Ger Gynecol Assoc. 2008;9(1):24‐28. [Google Scholar]

[pd5421-bib-0124] 124. Has R, Kalelioglu I, Esmer AC, et al. Bipolar cord coagulation in the management of complicated monochorionic twin pregnancies. Fetal Diagn Ther. 2014;36(3):190‐195. 10.1159/000360853 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0125] 125. He ZM, Fang Q, Yang YZ, et al. Fetal reduction by bipolar cord coagulation in managing complicated monochorionic multiple pregnancies: preliminary experience in China. Chin Med J (Engl). 2010;123(5):549‐554. 10.3760/cma.j.issn.0366-6999.2010.05.008 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0126] 126. Ilagan JG, Wilson RD, Bebbington M, et al. Pregnancy outcomes following bipolar umbilical cord cauterization for selective termination in complicated monochorionic multiple gestations. Fetal Diagn Ther. 2008;23(2):153‐158. 10.1159/000111598 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0127] 127. Jelin E, Hirose S, Rand L, et al. Perinatal outcome of conservative management versus fetal intervention for twin reversed arterial perfusion sequence with a small acardiac twin. Fetal Diagn Ther. 2010;27(3):138‐141. 10.1159/000295176 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0128] 128. King JR, Conturie CL, Ouzounian JG, Korst LM, Llanes A, Chmait RH. Umbilical cord occlusion via laser coagulation in monochorionic multifetal gestations before and after 20 weeks of gestation. Fetal Diagn Ther. 2017;42(1):9‐16. 10.1159/000448948 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0129] 129. Lanna MM, Rustico MA, Dell'Avanzo M, et al. Bipolar cord coagulation for selective feticide in complicated monochorionic twin pregnancies: 118 consecutive cases at a single center. Ultrasound Obstet Gynecol. 2012;39(4):407‐413. 10.1002/uog.11073 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0130] 130. Lee H, Bebbington M, Crombleholme TM. The North American fetal therapy network registry data on outcomes of radiofrequency ablation for twin‐reversed arterial perfusion sequence. Fetal Diagn Ther. 2013;33(4):224‐229. 10.1159/000343223 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0131] 131. Lewi L, Gratacos E, Ortibus E, et al. Pregnancy and infant outcome of 80 consecutive cord coagulations in complicated monochorionic multiple pregnancies. Am J Obstet Gynecol. 2006;194(3):782‐789. http://www.hlisd.org/LibraryDetail.aspx?LibraryID=3866 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0132] 132. Moise KJKY, Johnson A, Nickeleit V, et al. Radiofrequency ablation for selective reduction in the complicated monochorionic gestation. Am J Obstet Gynecol. 2008;198(2):198.e1‐198.e5. 10.1016/j.ajog.2007.07.043 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0133] 133. Nobili E, Paramasivam G, Kumar S. Outcome following selective fetal reduction in monochorionic and dichorionic twin pregnancies discordant for structural, chromosomal and genetic disorders. Aust N Z J Obstet Gynaecol. 2013;53(2):114‐118. 10.1111/ajo.12071 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0134] 134. Paramasivam G, Wimalasundera R, Wiechec M, Zhang E, Saeed F, Kumar S. Radiofrequency ablation for selective reduction in complex monochorionic pregnancies. BJOG. 2010;117(10):1294‐1298. 10.1111/j.1471-0528.2010.02624.x [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0135] 135. Peng R, Xie HN, Lin MF, et al. Clinical outcomes after selective fetal reduction of complicated monochorionic twins with radiofrequency ablation and bipolar cord coagulation. Gynecol Obstet Invest. 2016;81(6):552‐558. 10.1159/000445291 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0136] 136. Quintero RA, Romero R, Reich H, et al. In utero percutaneous umbilical cord ligation in the management of complicated monochorionic multiple gestations. Ultrasound Obstet Gynecol. 1996;8(1):16‐22. http://onlinelibrary.wiley.com/doi/10.1046/j.1469‐0705.1996.08010016.x/full [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0137] 137. Quintero RA, Chmait RH, Murakoshi T, et al. Surgical management of twin reversed arterial perfusion sequence. Am J Obstet Gynecol. 2006;194(4):982‐991. 10.1016/j.ajog.2005.10.195 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0138] 138. Roman A, Papanna R, Johnson A, et al. Selective reduction in complicated monochorionic pregnancies: radiofrequency ablation vs. bipolar cord coagulation. Ultrasound Obstet Gynecol. 2010;36(1):37‐41. 10.1002/uog.7567 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0139] 139. Schou KV, Jensen LN, Jørgensen C, Søgaard K, Tabor A, Sundberg K. Ultrasound‐guided bipolar umbilical cord occlusion in complicated monochorionic pregnancies: is there a learning curve. Fetal Diagn Ther. 2018;44(1):65‐71. 10.1159/000479104 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0140] 140. Sugibayashi R, Ozawa K, Sumie M, Wada S, Ito Y, Sago H. Forty cases of twin reversed arterial perfusion sequence treated with radio frequency ablation using the multistep coagulation method: a single‐center experience. Prenat Diagn. 2016;36(5):437‐443. 10.1002/pd.4800 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0141] 141. Takano M, Murata S, Fujiwara M, Hirata H, Nakata M. Experience of fetoscopic laser photocoagulation and cord transection for twin‐reversed arterial perfusion sequence. J Obstet Gynaecol Res. 2015;41(9):1326‐1329. 10.1111/jog.12720 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0142] 142. Taylor MJO, Shalev E, Tanawattanacharoen S, et al. Ultrasound‐guided umbilical cord occlusion using bipolar diathermy for stage III/IV twin‐twin transfusion syndrome. Prenat Diagn. 2002;22(1):70‐76. [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0143] 143. Tsao KJ, Feldstein VA, Albanese CT, et al. Selective reduction of acardiac twin by radiofrequency ablation. Am J Obstet Gynecol. 2002;187(3):635‐640. 10.1067/mob.2002.125242 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0144] 144. Zhang ZT, Yang T, Liu CX, Li N. Treatment of twin reversed arterial perfusion sequence with radiofrequency ablation and expectant management: a single center study in China. Eur J Obstet Gynecol Reprod Biol. 2018;225:9‐12. 10.1016/j.ejogrb.2018.03.046 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0145] 145. Deprest J, Jani J, Gratacos E, et al. Fetal intervention for congenital diaphragmatic hernia: the European experience. Semin Perinatol. 2005;29(2):94‐103. [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0146] 146. Harrison M, Keller R, Hawgood S. A randomized trial of fetal endoscopic tracheal occlusion for severe fetal congential diaphragmatic hernia. N Engl J Med. 2003;349(20):1916‐1924. [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0147] 147. Jani J, Gratacós E, Greenough A, et al. Percutaneous fetal endoscopic tracheal occlusion (FETO) for severe left‐sided congenital diaphragmatic hernia. Clin Obstet Gynecol. 2005;48(4):910‐922. [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0148] 148. Jani JC, Nicolaides KH, Gratacós E, Vandecruys H, Deprest JA, Group FT . Fetal lung‐to‐head ratio in the prediction of survival in severe left‐sided diaphragmatic hernia treated by fetal endoscopic tracheal occlusion (FETO). Am J Obstet Gynecol. 2006;195(6):1646‐1650. [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0149] 149. Jani JC, Nicolaides KH, Gratacós E, et al. Severe diaphragmatic hernia treated by fetal endoscopic tracheal occlusion. Ultrasound Obstet Gynecol. 2009;34(3):304‐310. 10.1002/uog.6450 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0150] 150. Jiménez JA, Eixarch E, DeKoninck P, et al. Balloon removal after fetoscopic endoluminal tracheal occlusion for congenital diaphragmatic hernia. Am J Obstet Gynecol. 2017;217(1):78 10.1016/j.ajog.2017.02.041 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0151] 151. Kosinski P, Wielgos M. Foetoscopic endotracheal occlusion (FETO) for severe isolated left‐sided congenital diaphragmatic hernia: single center polish experience. J Matern Neonatal Med. 2018;31(19):2521‐2526. 10.1080/14767058.2017.1344969 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0152] 152. Manrique S, Munar F, Andreu E, et al. Fetoscopic tracheal occlusion for the treatment of severe congenital diaphragmatic hernia: preliminary results. Rev Esp Anestesiol Reanim. 2008;55(7):407‐413. [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0153] 153. Peralta CFA, Sbragia L, Bennini JR, et al. Fetoscopic endotracheal occlusion for severe isolated diaphragmatic hernia: initial experience from a single clinic in Brazil. Fetal Diagn Ther. 2011;29(1):71‐77. 10.1159/000314617 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0154] 154. Persico N, Fabietti I, Ciralli F, et al. Fetoscopic Endoluminal tracheal occlusion in fetuses with severe diaphragmatic hernia: a three‐year single‐center experience. Fetal Diagn Ther. 2017;41(3):215‐219. 10.1159/000448096 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0155] 155. Ruano R, da Silva MM, Campos JADB, et al. Fetal pulmonary response after fetoscopic tracheal occlusion for severe isolated congenital diaphragmatic hernia. Obstet Gynecol. 2012;119(1):93‐101. 10.1097/AOG.0b013e31823d3aea [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0156] 156. Ruano R, Yoshisaki CT, da Silva MM, et al. A randomized controlled trial of fetal endoscopic tracheal occlusion versus postnatal management of severe isolated congenital diaphragmatic hernia. Ultrasound Obstet Gynecol. 2012;39(1):20‐27. 10.1002/uog.10142 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0157] 157. Ruano R, Peiro JL, da Silva MM, et al. Early fetoscopic tracheal occlusion for extremely severe pulmonary hypoplasia in isolated congenital diaphragmatic hernia: preliminary results. Ultrasound Obstet Gynecol. 2013;42(1):70‐76. 10.1002/uog.12414 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0158] 158. Arens C, Koch C, Veit M, et al. Anesthetic management for percutaneous minimally invasive fetoscopic surgery of spina bifida aperta: a retrospective, descriptive report of clinical experience. Anesth Analg. 2017;125(1):219‐222. [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0159] 159. Belfort MA, Whitehead WE, Shamshirsaz AA, et al. Fetoscopic open neural tube defect repair: development and refinement of a two‐port, carbon dioxide insufflation technique. Obstet Gynecol. 2017;129(4):734‐743. [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0160] 160. Degenhardt J, Schürg R, Winarno A, et al. Percutaneous minimal‐access fetoscopic surgery for spina bifida aperta. Part II: maternal management and outcome. Ultrasound Obstet Gynecol. 2014;44(5):525‐531. 10.1002/uog.13389 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0161] 161. Kohn J, Rao V, Sellner A, et al. Management of labor and delivery after fetoscopic repair of an open neural tube defect. Obstet Gynecol. 2018;131(6):1062‐1068. [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0162] 162. Pedreira DAL, Zanon N, de Sá RAM, et al. Fetoscopic single‐layer repair of open spina bifida using a cellulose patch: preliminary clinical experience. J Matern Fetal Neonatal Med. 2014;27(16):1613‐1619. 10.3109/14767058.2013.871701 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0163] 163. Pedreira DAL, Zanon N, Nishikuni K, et al. Endoscopic surgery for the antenatal treatment of myelomeningocele: the CECAM trial. Am J Obstet Gynecol. 2016;214(1):111 10.1016/j.ajog.2015.09.065 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0164] 164. Verbeek RJ, Heep A, Maurits NM, et al. Fetal endoscopic myelomeningocele closure preserves segmental neurological function. Dev Med Child Neurol. 2012;54(1):15‐22. 10.1111/j.1469-8749.2011.04148.x [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0165] 165. Ziemann M, Fimmers R, Khaleeva A. Partial amniotic carbon dioxide insufflation (PACI) during minimally invasive fetoscopic interventions on fetuses with spina bifida aperta. Surg Endosc. 2018;32(7):3138‐3148. Epub ahead. 10.1007/s00464-018-6029-z [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0166] 166. Morris RK, Malin GL, Quinlan‐Jones E, et al. Percutaneous vesicoamniotic shunting versus conservative management for fetal lower urinary tract obstruction (PLUTO): a randomised trial. Lancet. 2013;382(9903):1496‐1506. 10.1016/S0140-6736(13)60992-7 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pd5421-bib-0167] 167. Ruano R, Duarte S, Bunduki V, Giron AM, Srougi M, Zugaib M. Fetal cystoscopy for severe lower urinary tract obstruction‐‐initial experience of a single center. Prenat Diagn. 2010;30(1):30‐39. 10.1002/pd.2418 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0168] 168. Welsh A, Agarwal S, Kumar S, Smith RP, Fisk NM. Fetal cystoscopy in the management of fetal obstructive uropathy: experience in a single European Centre. Prenat Diagn. 2003;23(13):1033‐1041. 10.1002/pd.717 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0169] 169. Cavalheiro S, Moron AF, Almodin CG, et al. Fetal hydrocephalus. Childs Nerv Syst. 2011;27(10):1575‐1583. 10.1007/s00381-011-1539-1 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0170] 170. Mallmann MR, Graham V, Rösing B, et al. Thoracoamniotic shunting for fetal hydrothorax: predictors of intrauterine course and postnatal outcome. Fetal Diagn Ther. 2017;41(1):58‐65. 10.1159/000446110 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0171] 171. Kohl T, Hering R, Van de Vondel P, et al. Analysis of the stepwise clinical introduction of experimental percutaneous fetoscopic surgical techniques for upcoming minimally invasive fetal cardiac interventions. Surg Endosc. 2006;20(7):1134‐1143. [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0172] 172. Kohl T, Tchatcheva K, Weinbach J, et al. Partial amniotic carbon dioxide insufflation (PACI) during minimally invasive fetoscopic surgery: early clinical experience in humans. Surg Endosc. 2010;24(2):432‐444. 10.1007/s00464-009-0579-z [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0173] 173. Nivatpumin P, Pangthipampai P, Jirativanont T, Dej‐Arkom S, Triyasunant N, Tempeetikul T. Anesthetic techniques and incidence of complications in fetoscopic surgery. J Med Assoc Thai. 2016;99(5):602‐610. [PubMed] [Google Scholar]

[pd5421-bib-0174] 174. Peralta CFA, Sbragia L, Corrêa‐Silva EP, et al. Maternal complications following endoscopic surgeries in fetal medicine. Rev Bras Ginecol Obstet. 2010;32(6):260‐266. [PubMed] [Google Scholar]

[pd5421-bib-0175] 175. Thom EA. Maternal reproductive outcomes after in‐utero repair of myelomeningocele. Am J Obstet Gynecol. 2016;214(1). [Google Scholar]

[pd5421-bib-0176] 176. Wilson RD, Lemerand K, Johnson MP, et al. Reproductive outcomes in subsequent pregnancies after a pregnancy complicated by open maternal‐fetal surgery (1996‐2007). Am J Obstet Gynecol. 2010;203(3):209 10.1016/j.ajog.2010.03.029 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0177] 177. Gregoir C, Engels AC, Gomez O, et al. Fertility, pregnancy and gynecological outcomes after fetoscopic surgery for congenital diaphragmatic hernia. Hum Reprod. 2016;31(9):2024‐2030. 10.1093/humrep/dew160 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0178] 178. Le Lous M, Mediouni I, Chalouhi G, et al. Impact of laser therapy for twin‐to‐twin transfusion syndrome on subsequent pregnancy. Prenat Diagn. 2018;38(4):293‐297. 10.1002/pd.5227 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0179] 179. Vergote S, Lewi L, Gheysen W, De Catte L, Devlieger R, Deprest J. Subsequent fertility, pregnancy, and gynecologic outcomes after fetoscopic laser therapy for twin‐twin transfusion syndrome compared with normal monochorionic twin gestations. Am J Obstet Gynecol. 2018;218(4):447.e1‐447.e7. 10.1016/j.ajog.2018.01.013 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0180] 180. Mascarenhas MN, Flaxman SR, Boerma T, Vanderpoel S, Stevens GA. National, regional, and global trends in infertility prevalence since 1990: a systematic analysis of 277 health surveys. PLoS Med. 2012;9(12):1‐12. 10.1371/journal.pmed.1001356 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pd5421-bib-0181] 181. Wilcox A, Weinber C, O'Connor J, Baird D. Incidence of early pregnancy loss. N Engl J Med. 1988;319(4):189‐194. [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0182] 182. Andersen AN, Wohlfahrt J, Christens P, Olsen J, Melbye M, Nybo A. Maternal age and fetal loss: population based register linkage study. BMJ. 2000;320(June):1708‐1712. [DOI] [PMC free article] [PubMed] [Google Scholar]

[pd5421-bib-0183] 183. Herbert D, Lucke J, Dobson A. Pregnancy losses in young Australian women. Findings from the Australian longitudinal study on Women's health. Womens Health Issues. 2009;19(1):21‐29. 10.1016/j.whi.2008.08.007 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0184] 184. Blencowe H, Cousens S, Oestergaard MZ, et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet. 2012;379(9832):2162‐2172. 10.1016/S0140-6736(12)60820-4 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0185] 185. Tanne JH. Preterm and low weight births rise again in the US. BMJ. 2017;3311:j3311 10.1136/bmj.j3311 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0186] 186. National Institute for Health and Care Excellence . Preterm labour and birth. 2015. nice.org.uk/guidance/ng25. [PubMed]

[pd5421-bib-0187] 187. Greene RA, Fitzpatrick C, Turner MJ. What are the maternal implications of a classical caesarean section? J Obstet Gynaecol. 1998;18(4):345‐347. 10.1080/01443619867083 [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0188] 188. Shavit C, Rollins M, Ferschl M. Maternal convulsion during high‐dose sevoflurane anaesthesia for open foetal surgery. Br J Anaesth. 2017;118(4):634‐635. [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0189] 189. Gratacós E, Deprest J. Current experience with fetoscopy and the Eurofoetus registry for fetoscopic procedures. Eur J Obstet Gynecol Reprod Biol. 2000;92(1):151‐159. [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0190] 190. NAFTNet Website . https://www.naftnet.org.

[pd5421-bib-0191] 191. Bliton MJ. Parental hope confronting scientific uncertainty: a test of ethics in maternal‐fetal surgery for spina bifida. Clin Obstet Gynecol. 2005;48(3):595‐607. [DOI] [PubMed] [Google Scholar]

[pd5421-bib-0192] 192. Fry JT, Frader JE. “We want to do everything”: how parents represent their experiences with maternal‐fetal surgery online. J Perinatol. 2018;38(3):226‐232. 10.1038/s41372-017-0040-4 [DOI] [PubMed] [Google Scholar]

PERMALINK

Maternal complications following open and fetoscopic fetal surgery: A systematic review and meta‐analysis

Adalina Sacco

Lennart Van der Veeken

Emma Bagshaw

Catherine Ferguson

Tim Van Mieghem

Anna L David

Jan Deprest

Abstract

Objective

Methods

Results

Conclusions

Short abstract

1. INTRODUCTION

What's already known about this topic?

What does this study add?

2. METHODS

2.1. Protocol and registration

2.2. Eligibility criteria

2.3. Search strategy

2.4. Study selection

2.5. Data extraction

2.6. Quality assessment of studies

2.7. Assessment of heterogeneity

2.8. Meta‐analysis

3. RESULTS

3.1. Study selection

Figure 1.

3.2. Study characteristics

Table 1.

Table 2.

Table 3.

3.3. Risk of bias

3.4. Statistical heterogeneity

3.5. Maternal complications in the index pregnancy—intraoperative

Table 4.

3.6. Maternal complications in the index pregnancy—postoperative

3.7. Maternal complications in the index pregnancy—at delivery

3.8. Overall maternal complication rates

Table 5.

3.9. Maternal outcomes following the index pregnancy (long‐term)

Table 6.

4. DISCUSSION

5. CONCLUSION

CONFLICT OF INTEREST

FUNDING INFORMATION

Supporting information

REFERENCES

Associated Data

Supplementary Materials

ACTIONS

PERMALINK

RESOURCES

Similar articles

Cited by other articles

Links to NCBI Databases