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

Am J Perinatol. 2018 Jul;35(8):801-808. doi: 10.1055/s-0037-1620268. Epub 2018 Jan 10.


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

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

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

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

MeSH terms

  • Female
  • Fetal Membranes, Premature Rupture / etiology*
  • Fetofetal Transfusion / surgery*
  • Fetoscopy / adverse effects*
  • Fetoscopy / methods
  • Gestational Age
  • Humans
  • Infant, Newborn
  • Logistic Models
  • Pregnancy
  • Pregnancy, Twin
  • Premature Birth / etiology
  • Retrospective Studies
  • Risk Factors
  • Surgical Instruments / adverse effects*
  • Treatment Outcome
  • Twins, Monozygotic

Supplementary concepts

  • Preterm Premature Rupture of the Membranes