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The treatment of the mildest form of twin transfusion syndrome (TTTS), Quintero Stage1, is actually under debate.
Outcomes of Stage1-TTTS treated by amnioreduction (AR), conservative management (CM) or laser therapy (LT) are
reviewed. Inclusion criteria: TTTS diagnosed according to standard criteria, Stage1 defi
ned by sonographic visualization of
donors� bladder. Articles not aimed to analyse survival rates of Stage1 were excluded. Th
e overall survival rate (OSR) and
survivors for twin set were abstracted from each article. PRISMA guidelines were followed. Eight articles reported outcomes
of Stage1 in 269 twin sets. First choice treatment was AR in 40 (15%), CM in 59 (22%), LT in 170 (63%). In the AR group, OSR
was 66/80_82%. For twin set, 0, 1 or 2 survivors were 2/40_5%, 13/40_32% and 25/40_62%, respectively. At least 1 survival
rate was 42/80_52%. In the CM group, OSR was 102/118_86%. For twin set, 0, 1 and 2 survivors were 3/59_5%, 10//59_17%
and 46/59_78%, respectively. At least 1 survival rate was 56/59_95%. Stage1 progressed to advanced stages in 13/40_32% and
6/39_15% cases treated with AR and CM respectively. In the LT group, OSR was 291/340_85%. For twin set, 0,1 and 2 survivors
were 12/170_7%, 25/170_15% and 133/170_78%, respectively. At least 1 survivor rate was 158/170_93%. Only one article
compared outcomes following LT vs CM and did not fi
erences in survival rates. Th
us, a meta-analysis was not performed.
Although comparative studies are needed, literature shows that AR is associated with low survival rates and LT does not appear
superior to CM.
A. Cristina Rossi was born on 6 Sept 1974 and received her degree in Medicine and Residency in Obstetrics and Gynecology at Uni versity of Bari (Bari, Italy), where she is actually Research Fellow. She has published about 30 papers, mainly in the fi eld of Fetal and Maternal Medicine. She was presenting Author to international meetings of the Society of Maternal and Fetal Medicine.
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