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Efficacy of Long Term Indomethacin Therapy in Prolonging Pregnancy After Fetoscopic Laser Surgery for Twin-to-Twin Transfusion Syndrome: a Collaborative Cohort Study
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  • Hiba Mustafa,
  • Eyal Krispin,
  • Hooman Tadbiri,
  • Jimmy Espinoza,
  • Alireza Shamshirsaz,
  • Ahmed Nassr,
  • Roopali Donepudi,
  • Michael Belfort (FETAL MEDICINE ISSUE EDITOR),
  • Magdalena Sanz Cortes,
  • Nicole Pedersen,
  • Christopher Harman,
  • Ozhan Turan
Hiba Mustafa
University of Maryland Baltimore
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Eyal Krispin
Baylor College of Medicine
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Hooman Tadbiri
University of Maryland Baltimore
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Jimmy Espinoza
Baylor College of Medicine and Texas Childrens Hospital Pavilion for Women, Houston, TX, United States
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Alireza Shamshirsaz
Baylor College of Medicine
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Ahmed Nassr
Baylor College of Medicine
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Roopali Donepudi
Baylor College of Medicine and Texas Childrens Hospital Pavilion for Women, Houston, TX, United States
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Michael Belfort (FETAL MEDICINE ISSUE EDITOR)
Baylor College of Medicine
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Magdalena Sanz Cortes
BAYLOR COLLEGE OF MEDICINE, TEXAS
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Nicole Pedersen
University of Maryland Baltimore
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Christopher Harman
University of Maryland School of Medicine
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Ozhan Turan
University of Maryland School of Medicine
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Abstract

Objective: To evaluate the efficacy of long-term indomethacin therapy (LIT) in prolonging pregnancy and reducing spontaneous preterm birth (PTB) in patients undergoing fetoscopic laser surgery (FLS) for the management of twin-to-twin transfusion syndrome (TTTS). Design: Retrospective cohort study of prospectively collected data. Setting: Collaborative multicenter study Population: 557 consecutive TTTS cases that underwent FLS Methods: LIT was defined as indomethacin use for at least 48 hours. Log-binomial regression was used to estimate the relative risk (RR) of PTB in LIT compared to non-LIT group. Cox regression was used to evaluate the association between LIT use and FLS-to-delivery survival. Main outcome measures: gestational age (GA) at delivery Results: Among the 411 pregnancies included, a total of 180 patients (43.8%) received LIT after FLS and 231 patients (56.2%) did not. Median GA at fetal intervention did not differ between groups (20.4 weeks). Median GA at delivery was significantly higher in the LIT group (33.6 weeks) compared to the non-LIT group (31.1weeks), p<0.001. FLS-to-delivery interval was significantly longer in the LIT group (P<0.001). The risk of PTB prior to 34, 32, 28, and 26 weeks gestation were all significantly lower in the LIT group compared to the non-LIT group (RR=0.69, 0.51, 0.37, and 0.18, respectively). The number needed to treat (NNT) with LIT to prevent one PTB<32 weeks gestation was 4, and to prevent one PTB<34 weeks was 5. Conclusion: Long-term indomethacin after FLS for TTTS was found to be associated with prolongation of pregnancy and reducing the risk for PTB.

Peer review status:ACCEPTED

01 Jul 2021Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
06 Jul 2021Submission Checks Completed
06 Jul 2021Assigned to Editor
10 Jul 2021Reviewer(s) Assigned
25 Jul 2021Review(s) Completed, Editorial Evaluation Pending
24 Aug 2021Editorial Decision: Revise Major
03 Sep 20211st Revision Received
05 Sep 2021Submission Checks Completed
05 Sep 2021Assigned to Editor
05 Sep 2021Review(s) Completed, Editorial Evaluation Pending
14 Sep 2021Editorial Decision: Accept