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 multicentre study.
Population: Five hundred and fifty-seven consecutive TTTS cases that underwent FLS.
Methods: Long-term indomethacin therapy was defined as indomethacin use for at least 48 hours. Log-binomial regression was used to estimate the relative risk of PTB in the LIT group compared with a 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 with the non-LIT group (31.1 weeks; P < 0.001). FLS-to-delivery interval was significantly longer in the LIT group (P < 0.001). The risks of PTB before 34, 32, 28 and 26 weeks of gestation were all significantly lower in the LIT group compared with the non-LIT group (relative risks 0.69, 0.51, 0.37 and 0.18, respectively). The number needed to treat with LIT to prevent one PTB before 32 weeks of gestation was four, and to prevent one PTB before 34 weeks was five.
Conclusion: Long-term indomethacin after FLS for TTTS was found to be associated with prolongation of pregnancy and reduced risk for PTB.
Tweetable Abstract: Long-term indomethacin used after fetoscopic laser surgery for twin-to-twin transfusion syndrome is effective in prolonging pregnancy and reducing the risk for preterm birth; especially extreme preterm birth.
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http://dx.doi.org/10.1111/1471-0528.17017 | DOI Listing |
Int J Surg Case Rep
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Joint Reconstruction Research Center (JRRC), Imam Khomeini Hospital, Tehran University of Medical Sciences, End of Keshavarz Blvd, 1419733141 Tehran, Iran. Electronic address:
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View Article and Find Full Text PDFPharmaceutics
November 2024
Department of Pharmaceutics, School of Pharmacy, Guangdong Pharmaceutical University, Guangzhou Higher Education Mega Center, 280 East Waihuan Road, Guangzhou 510006, China.
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View Article and Find Full Text PDFPharmaceuticals (Basel)
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College of Science and Engineering, Flinders University, Bedford Park, South Australia 5042, Australia.
Two fibre optic probes were custom designed to perform Raman and near-infrared spectroscopic measurements. Our long-term objective is to develop a non-destructive tool able to collect data in hard-to-access locations for real-time analysis or diagnostic purposes. This study evaluated the quantitative performances of Probe A and Probe B using model pharmaceutical tablets.
View Article and Find Full Text PDFPharm Dev Technol
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View Article and Find Full Text PDFJAMA Pediatr
December 2024
Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
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