This study analyzed outcomes of twin reversed arterial perfusion (TRAP) sequence cases managed expectantly or with intrafetal laser therapy. It found that intrafetal laser treatment significantly improved outcomes compared to expectant management, with a fetal survival rate of 82% versus 0%. A systematic review of 10 studies found an overall neonatal survival rate of 80% following laser therapy. Adverse outcomes were significantly lower when treatment occurred before 16 weeks of gestation. The study concluded that intrafetal laser therapy, especially before 16 weeks, can improve pregnancy outcomes in TRAP sequences compared to expectant management alone.
Study of the distribution and determinants of
health-related states or events in specified populations and the application of this study to control health problems.
John M. Last, Dictionary of Epidemiology
When is it time for a new cancer treatment, and how should patients make these difficult decisions? Rachel Yung, MD, provides an overview of what to consider when making difficult treatment choices.
The objective of this study was to observe the 1-year and 2-year pressure reduction in an active population of glaucoma patients treated by selective laser trabeculoplasty. We carried out a retrospective study of all patients treated in our department between January 2015 and March 2016. Patients who had already undergone Laser Trabeculoplasty (ALT or SLT) in the past were excluded from the study. Treatment was performed with a Q-Switched, frequency doubled Nd: YAG laser (Solutis - Quantel Medical, France), over 180° or 360° of the trabecular meshwork. The mean decrease in intraocular pressure and the success zrate, defi ned as a decrease in intraocular pressure superior to 20% without increasing the medical treatment, were calculated. The impact of the different clinical and technical characteristics on the decrease in pressure was also studied by multivariate analysis. One hundred and seventeen eyes, in 74 patients, were included. The mean decrease in IOP from baseline was 4.35 mmHg (20.6%) at 1 year and 3.74 mmHg (16.7%) at 2 years. The success rate was 49% at 1 year and 33.3% at 2 years. Selective trabeculoplasty is currently a therapeutic option called-upon at different stages in the progression of glaucoma. The duration of effi cacy of this laser therapy, and the retreatment frequency are yet to be defined.
Clinical prediction rule in spinal painNityal Kumar
This lecture is on spinal pain and the clinical methods used in treating the pain. Clinical prediction rules is a research method done systematically describing when to use which method of treatment approach
Study of the distribution and determinants of
health-related states or events in specified populations and the application of this study to control health problems.
John M. Last, Dictionary of Epidemiology
When is it time for a new cancer treatment, and how should patients make these difficult decisions? Rachel Yung, MD, provides an overview of what to consider when making difficult treatment choices.
The objective of this study was to observe the 1-year and 2-year pressure reduction in an active population of glaucoma patients treated by selective laser trabeculoplasty. We carried out a retrospective study of all patients treated in our department between January 2015 and March 2016. Patients who had already undergone Laser Trabeculoplasty (ALT or SLT) in the past were excluded from the study. Treatment was performed with a Q-Switched, frequency doubled Nd: YAG laser (Solutis - Quantel Medical, France), over 180° or 360° of the trabecular meshwork. The mean decrease in intraocular pressure and the success zrate, defi ned as a decrease in intraocular pressure superior to 20% without increasing the medical treatment, were calculated. The impact of the different clinical and technical characteristics on the decrease in pressure was also studied by multivariate analysis. One hundred and seventeen eyes, in 74 patients, were included. The mean decrease in IOP from baseline was 4.35 mmHg (20.6%) at 1 year and 3.74 mmHg (16.7%) at 2 years. The success rate was 49% at 1 year and 33.3% at 2 years. Selective trabeculoplasty is currently a therapeutic option called-upon at different stages in the progression of glaucoma. The duration of effi cacy of this laser therapy, and the retreatment frequency are yet to be defined.
Clinical prediction rule in spinal painNityal Kumar
This lecture is on spinal pain and the clinical methods used in treating the pain. Clinical prediction rules is a research method done systematically describing when to use which method of treatment approach
Prevention of pre-eclampsia by low-molecular-weight
heparin in addition to aspirin: a meta-analysis
S. Roberge, S. Demers, K. H. Nicolaides, M. Bureau, S. Côté and E. Bujold
Volume 47, Issue 5, Pages 548–553
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.15789/full
The aim of this study was to assess the interobserver variation among surgeons in grading of the inflammatory severity of acute appendicitis as recognized on visual findings at operation.
UOG Journal Club: Use of IOTA simple rules for diagnosis of ovarian cancer: meta-analysis
N. Nunes, G. Ambler, X. Foo, J. Naftalin, M. Widschwendter and D. Jurkovic
http://onlinelibrary.wiley.com/doi/10.1002/uog.13437/abstract
A thoughtful presentation on participation in clinical trials from the Thomas Jefferson University team at the 2017 CURE OM Patient & Caregiver Symposium.
Randomized controlled trial of toremifene 120 mg compared with exemestane 25 ...Enrique Moreno Gonzalez
After the failure of a non-steroidal aromatase inhibitor (nsAI) for postmenopausal patients with metastatic breast cancer (mBC), it is unclear which of various kinds of endocrine therapy is the most appropriate. A randomized controlled trial was performed to compare the
efficacy and safety of daily toremifene 120 mg (TOR120), a selective estrogen receptor
modulator, and exemestane 25 mg (EXE), a steroidal aromatase inhibitor. The primary end point was the clinical benefit rate (CBR). The secondary end points were objective response
rate (ORR), progression-free survival (PFS), overall survival (OS) and toxicity.
This presentation by Gail Clayton, Lead MS Clinical Nurse Specialist and Jacki Smee, MS Clinical Nurse Specialist at Cardiff and Vale University Health Board explores setting up an Alemtuzumab service. It includes: patient selection, infusion related and long-term side-effects, ongoing monitoring requirements, potential challenges and case studies.
It was presented at the MS Trust Annual Conference in November 2013.
Judith Goldberg MedicReS World Congress 2014MedicReS
Statistics in Clinical and Translational Research in Drug Development - Judith D. Goldberg, Sc.D. Professor
Division of Biostatistics New York University School of Medicine
Clinical implementation of routine screening for fetal trisomies in the UK NHS: cell-free DNA test contingent on results from first-trimester combined test
M. M. Gil, R. Revello, L. C. Poon, R. Akolekar and K. H. Nicolaides
Volume 47, Issue 1; pages 45–52
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.15783/full
Neurodevelopmental outcome in isolated mild fetal ventriculomegaly: systematic review and meta-analysis
G. Pagani, B. Thilaganathan and F. Prefumo
Volume 44, Issue 3, Date: September 2014, Pages 254-260
http://onlinelibrary.wiley.com/doi/10.1002/uog.13364/abstract
Systematic review of accuracy of ultrasound in the diagnosis of vasa previa
L. Ruiter, N. Kok, J. Limpens, J.B. Derks, I.M. de Graaf, B.W.J. Mol and E. Pajkrt
Volume 45, Issue 5, pages 516–522, May 2015
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.14752/full
The UOG Journal Club for June 2013 features two papers on the detection of obliteration of the pouch of Douglas and rectal involvement in DIE using a ‘uterine sliding sign’ on TVS:
Prediction of pouch of Douglas obliteration in women with suspected endometriosis using a new real-time dynamic transvaginal ultrasound technique: the sliding sign
S. Reid, C. Lu, I. Casikar, G. Reid, J. Abbott, G. Cario, D. Chou, D. Kowalski, M. Cooper, and G. Condous
Volume 41, Issue 6, Date: June 2013, pages 685–691
http://onlinelibrary.wiley.com/doi/10.1002/uog.12305/abstract
Uterine sliding sign: a simple sonographic predictor for presence of deep infiltrating endometriosis of the rectum
G. Hudelist, N. Fritzer, S. Staettner, A. Tammaa, A. Tinelli, R. Sparic, and J. Keckstein
Volume 41, Issue 6, Date: June 2013, pages 692–695
http://onlinelibrary.wiley.com/doi/10.1002/uog.12431/abstract
Prevention of pre-eclampsia by low-molecular-weight
heparin in addition to aspirin: a meta-analysis
S. Roberge, S. Demers, K. H. Nicolaides, M. Bureau, S. Côté and E. Bujold
Volume 47, Issue 5, Pages 548–553
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.15789/full
The aim of this study was to assess the interobserver variation among surgeons in grading of the inflammatory severity of acute appendicitis as recognized on visual findings at operation.
UOG Journal Club: Use of IOTA simple rules for diagnosis of ovarian cancer: meta-analysis
N. Nunes, G. Ambler, X. Foo, J. Naftalin, M. Widschwendter and D. Jurkovic
http://onlinelibrary.wiley.com/doi/10.1002/uog.13437/abstract
A thoughtful presentation on participation in clinical trials from the Thomas Jefferson University team at the 2017 CURE OM Patient & Caregiver Symposium.
Randomized controlled trial of toremifene 120 mg compared with exemestane 25 ...Enrique Moreno Gonzalez
After the failure of a non-steroidal aromatase inhibitor (nsAI) for postmenopausal patients with metastatic breast cancer (mBC), it is unclear which of various kinds of endocrine therapy is the most appropriate. A randomized controlled trial was performed to compare the
efficacy and safety of daily toremifene 120 mg (TOR120), a selective estrogen receptor
modulator, and exemestane 25 mg (EXE), a steroidal aromatase inhibitor. The primary end point was the clinical benefit rate (CBR). The secondary end points were objective response
rate (ORR), progression-free survival (PFS), overall survival (OS) and toxicity.
This presentation by Gail Clayton, Lead MS Clinical Nurse Specialist and Jacki Smee, MS Clinical Nurse Specialist at Cardiff and Vale University Health Board explores setting up an Alemtuzumab service. It includes: patient selection, infusion related and long-term side-effects, ongoing monitoring requirements, potential challenges and case studies.
It was presented at the MS Trust Annual Conference in November 2013.
Judith Goldberg MedicReS World Congress 2014MedicReS
Statistics in Clinical and Translational Research in Drug Development - Judith D. Goldberg, Sc.D. Professor
Division of Biostatistics New York University School of Medicine
Clinical implementation of routine screening for fetal trisomies in the UK NHS: cell-free DNA test contingent on results from first-trimester combined test
M. M. Gil, R. Revello, L. C. Poon, R. Akolekar and K. H. Nicolaides
Volume 47, Issue 1; pages 45–52
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.15783/full
Neurodevelopmental outcome in isolated mild fetal ventriculomegaly: systematic review and meta-analysis
G. Pagani, B. Thilaganathan and F. Prefumo
Volume 44, Issue 3, Date: September 2014, Pages 254-260
http://onlinelibrary.wiley.com/doi/10.1002/uog.13364/abstract
Systematic review of accuracy of ultrasound in the diagnosis of vasa previa
L. Ruiter, N. Kok, J. Limpens, J.B. Derks, I.M. de Graaf, B.W.J. Mol and E. Pajkrt
Volume 45, Issue 5, pages 516–522, May 2015
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.14752/full
The UOG Journal Club for June 2013 features two papers on the detection of obliteration of the pouch of Douglas and rectal involvement in DIE using a ‘uterine sliding sign’ on TVS:
Prediction of pouch of Douglas obliteration in women with suspected endometriosis using a new real-time dynamic transvaginal ultrasound technique: the sliding sign
S. Reid, C. Lu, I. Casikar, G. Reid, J. Abbott, G. Cario, D. Chou, D. Kowalski, M. Cooper, and G. Condous
Volume 41, Issue 6, Date: June 2013, pages 685–691
http://onlinelibrary.wiley.com/doi/10.1002/uog.12305/abstract
Uterine sliding sign: a simple sonographic predictor for presence of deep infiltrating endometriosis of the rectum
G. Hudelist, N. Fritzer, S. Staettner, A. Tammaa, A. Tinelli, R. Sparic, and J. Keckstein
Volume 41, Issue 6, Date: June 2013, pages 692–695
http://onlinelibrary.wiley.com/doi/10.1002/uog.12431/abstract
Screening for trisomies 21, 18 and 13 by cell-free DNA analysis of maternal blood at 10–11 weeks’ gestation and the combined test at 11–13 weeks
M. S. Quezada, M. M. Gil, C. Francisco, G. Oròsz and K. H. Nicolaides
Volume 45, Issue 1, pages 36–41, January 2015
http://onlinelibrary.wiley.com/doi/10.1002/uog.14664/full
UOG Journal Club: October 2013
Perinatal morbidity and mortality in early-onset fetal growth restriction: cohort outcomes of the trial of randomized umbilical and fetal flow in Europe (TRUFFLE)
C. Lees, N. Marlow, B. Arabin, C. M. Bilardo, C. Brezinka, J. B. Derks, J. Duvekot, T. Frusca, A. Diemert, E. Ferrazzi, W. Ganzevoort, K. Hecher, P. Martinelli, E. Ostermayer, A. T. Papageorghiou, D. Schlembach, K. T. M. Schneider, B. Thilaganathan, T. Todros, A. van Wassenaer-Leemhuis, A. Valcamonico, G. H. A. Visser and H. Wolf
Link to the free-access article:
http://onlinelibrary.wiley.com/doi/10.1002/uog.13190/abstract
Accompanying slides for the Ultrasound in Obstetrics and Gynecology article 'How to perform an amniocentesis' by M. Cruz-Lemini, M. Parra-Saavedra, V. Borobio, M. Bennasar, A. Goncé, J. M. Martínez and A. Borrell
You can find the full article here:
http://onlinelibrary.wiley.com/doi/10.1002/uog.14680/abstract
Single deepest vertical pocket or amniotic fluid index as evaluation test for predicting adverse pregnancy outcome (SAFE trial): a multicenter, open‐label, randomized controlled trial
S Kehl, A Schelkle, A Thomas, A Puhl, K Meqdad, B Tuschy, S Berlit, C Weiss, C Bayer, J Heimrich, U Dammer, E Raabe, M Winkler, F Faschingbauer, MW Beckmann, M Sutterlin
Volume 47, Issue 6, Date: June (pages 674–679)
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.14924/full
Ability of a preterm surveillance clinic to triage risk of preterm birth: a prospective cohort study
J Min, HA Watson, NL Hezelgrave, PT Seed and AH Shennan
Volume 48, Issue 1, pages 38–42
Slides prepared Dr Joel Naftalin (UOG Editor for Trainees)
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.15925/full
Dydrogesterone versus progesterone for luteal-phase support: systematic review and meta-analysis of randomized controlled trials
M. W. P. Barbosa, L. R. Silva, P. A. Navarro, R. A. Ferriani, C. O. Nastri and W. P. Martins
Volume 48, Issue 2, Pages 161–170
Slides prepared by Dr Aly Youssef (UOG Editor for Trainees)
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.15814/full
UOG Journal Club: October 2013
Endometrial scratching performed in the non-transfer cycle and outcome of assisted reproduction: a randomized controlled trial
CO Nastri, RA Ferriani, N Raine-Fenning, WP Martins
Volume 42, Issue 4, Date: October 2013, pages 375–382
Link to free access article:
http://onlinelibrary.wiley.com/doi/10.1002/uog.12539/abstract
International Journal of Engineering Research and Development (IJERD)IJERD Editor
journal publishing, how to publish research paper, Call For research paper, international journal, publishing a paper, IJERD, journal of science and technology, how to get a research paper published, publishing a paper, publishing of journal, publishing of research paper, reserach and review articles, IJERD Journal, How to publish your research paper, publish research paper, open access engineering journal, Engineering journal, Mathemetics journal, Physics journal, Chemistry journal, Computer Engineering, Computer Science journal, how to submit your paper, peer reviw journal, indexed journal, reserach and review articles, engineering journal, www.ijerd.com, research journals,
yahoo journals, bing journals, International Journal of Engineering Research and Development, google journals, hard copy of journal
An Integrated Multi-Criteria Approach on Vulnerability Analysis in the Contex...Mirjam-Mona
Presentation of Thomas Münzberg, Tim Müller, Stella Möhrle, Tina Comes and Frank Schultmann on the topic "An Integrated Multi-Criteria Approach on Vulnerability Analysis in the Context of Load Reduction" at ISCRAM2013
International Journal of Pharmaceutical Science Invention (IJPSI)inventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online
Breast surgery for Metastatic Breast Cancer : Cochrane Analysis Kundan Singh
Breast surgery plus systemic treatment may improve local PFS when compared to systemic treatment alone (HR 0.22, 95% CI 0.08 to 0.57; 2 studies; 607 women; I2 = 43%; low quality evidence)
The group receiving breast surgery plus systemic treatment probably had a shorter time
to distant PFS compared to the group receiving systemic treatment alone (HR 1.42, 95%CI 1.08 to 1.86; 1 study; 350 women; moderate-quality evidence)
Uterine Fibroids: Symptoms, Causes, Risk Factors & Treatment uterine fibroids aren't associated with an increased risk of uterine cancer and almost never develop into cancer
1. UOG Journal Club: July 2013
Intrafetal laser treatment for twin reversed arterial perfusion sequence:
cohort study and meta-analysis
G. Pagani, F. D’Antonio, A. Khalil, A. Papageorghiou, A. Bhide and B. Thilaganathan
Volume 42, Issue 1, Date: July 2013, pages 6–14
Journal Club slides prepared by
Dr. Katherine Goetzinger
(UOG Editor for Trainees)
2. Intrafetal laser treatment for twin reversed arterial perfusion sequence: cohort study and
meta-analysis
Pagani et al., UOG 2013
• Twin reversed arterial perfusion (TRAP) sequence is a unique
complication of monochorionic twins
• TRAP sequence is characterized by retrograde perfusion of an
acardiac mass by a normal (pump) twin through placental
arterioarterial anastomoses
• TRAP sequence results in a hyperdynamic circulation and high
output cardiac failure of the pump twin
• The goal of antenatal management has been to prevent demise of
the pump twin by intrauterine therapy when cardiac strain of the
pump twin or increased growth of the acardiac twin occurs
3. 1. To ascertain the outcome of TRAP cases managed either
expectantly or with intrafetal laser therapy in a single center
2. To systematically review the literature to assess outcomes of
TRAP cases treated with intrafetal laser therapy
Objectives
Intrafetal laser treatment for twin reversed arterial perfusion sequence: cohort study and
meta-analysis
Pagani et al., UOG 2013
4. Inclusion Criteria: All TRAP cases identified from 2000-2012
Exposure: Expectant management vs fetal laser when indicated
• Fetal laser indicated by rapid growth of the TRAP mass, development of a
hyperdynamic circulation, or cardiac strain in the pump twin
Outcomes: Fetal loss, gestational age at demise, GA at live birth, birth weight,
gestational age interval from treatment to delivery
Methodology
Intrafetal laser treatment for twin reversed arterial perfusion sequence: cohort study and
meta-analysis
Pagani et al., UOG 2013
Retrospective Cohort Study
5. Inclusion Criteria: Studies reporting the outcome of TRAP cases treated by laser
therapy
Outcomes: Overall survival and preterm birth
Analysis:
•Forest plots: fixed and random effects models
•Between-study heterogeneity: Higgin’s I2
•Publication bias: Funnel plots and Begg and Mazumdar’s rank correlation test
•Cases stratified by gestational age at therapy (<16 vs ≥16 weeks)
Systematic Review & Meta-Analysis
Intrafetal laser treatment for twin reversed arterial perfusion sequence: cohort study and
meta-analysis
Pagani et al., UOG 2013
Methodology
6. Expectant
management
(n = 6)
Intrafetal laser
treatment
(n = 17)
GA at presentation (weeks) 13 + 3 13 + 3
GA at treatment (weeks) --- 18 + 4
Fetal loss 6 (100%) 3 (18%)
GA at demise (weeks) 14 + 4 22 + 1
Fetal survival 0 (0%) 14 (82%)
GA at live birth (weeks) --- 37 + 1
Birth weight (g) --- 2530 g
Retrospective Cohort
Intrafetal laser treatment for twin reversed arterial perfusion sequence: cohort study and
meta-analysis
Pagani et al., UOG 2013
Results
Data presented as n (%) or median.
7. Potentially appropriate studies identified from search
(n = 81)
Citations retrieved for detailed evaluation of
manuscript
(n = 23)
Studies included in systematic review
(n = 10)
Citations excluded based on
title or abstract
(n = 58)
Studies excluded
(n = 13)
These 10 studies included 34 pregnancies complicated by TRAP sequence which
were treated by intrafetal laser
Intrafetal laser treatment for twin reversed arterial perfusion sequence: cohort study and
meta-analysis
Pagani et al., UOG 2013
Results: Systematic Review
8. 0.0 0.2 0.4 0.6 0.8 1.0
Combined 0.80 (0.69, 0.89)
This study 0.82 (0.57, 0.96)
Wegrzyn 2012 1.00 (0.03, 1.00)
Scheier 2011 0.86 (0.42, 1.00)
Lewi 2010 0.83 (0.36, 1.00)
Sepulveda 2009 1.00 (0.16, 1.00)
Cavoretto 2009 1.00 (0.03, 1.00)
O'Donoghue 2008 0.60 (0.26, 0.88)
Weisz 2004 1.00 (0.16, 1.00)
Sepulveda 2004 1.00 (0.03, 1.00)
Soothill 2002 1.00 (0.16, 1.00)
Jolly 2001 1.00 (0.16, 1.00)
Proportion (95% confidence interval)
42/51
14/17
1/1
6/7
5/6
2/2
1/1
6/10
2/2
1/1
2/2
2/2
I2 = 0% (95% CI = 0% to
51.2%)
Study n/N
The overall neonatal
survival after intrafetal
laser treatment was
80% (95% CI, 69–89%)
There was no
significant
heterogeneity between
studies
(I2
= 0%)
Intrafetal laser treatment for twin reversed arterial perfusion sequence: cohort study and
meta-analysis
Pagani et al., UOG 2013
Results: Systematic Review
9. • The overall risk of PTB <37 weeks was 40% (95% CI, 27– 59%) with
no evidence of statistically significant heterogeneity (I2
= 24.8%)
• The overall risk of PTB <32 weeks was 7% (95% CI, 4–21%)
• Adverse pregnancy outcome (fetal demise and PTB <37 weeks)
was significantly lower (p=0.0025) when treatment occurred <16
weeks (19%) compared ≥16 weeks (66%)
Intrafetal laser treatment for twin reversed arterial perfusion sequence: cohort study and
meta-analysis
Pagani et al., UOG 2013
Results: Systematic Review
10. Bias assessment plot
0.2 0.5 0.8 1.1 1.4
0.26
0.22
0.18
0.14
0.10
Proportion
Standard error
Bias assessment plot
-0.20 0.05 0.30 0.55 0.80 1.05
0.25
0.22
0.19
0.16
0.13
Proportion
Standard error
No evidence of significant publication bias
Neonatal survival
P = 0.19
PTB <37 weeks
P = 0.10
Intrafetal laser treatment for twin reversed arterial perfusion sequence: cohort study and
meta-analysis
Pagani et al., UOG 2013
Results: Systematic Review
11. • Expectant management of TRAP sequence has a high fetal loss rate
• Serial ultrasound and Doppler monitoring is ineffective at identifying TRAP
cases at high risk of fetal demise
• Early intervention with intrafetal laser treatment may improve pregnancy
outcomes in cases of TRAP, especially if performed prior to 16 weeks
Intrafetal laser treatment for twin reversed arterial perfusion sequence: cohort study and
meta-analysis
Pagani et al., UOG 2013
Conclusions
• Routine intrafetal laser therapy prior to 16 weeks’ gestation should be
considered in pregnancies affected by TRAP sequence in order to reduce
associated adverse pregnancy outcomes
Implications for practice
12. • Large series of cases
• Meta-analysis to overcome sample
size issues
• Stratified analysis performed based
on gestational age
• No significant heterogeneity
between studies
Strengths
• No randomized comparison group
• Use of composite outcome in
stratified analysis
• Potential for publication bias
• Variable quality of studies included
with none reporting efforts to reduce
bias
• Range of laser technique and
experience between studies is likely
Limitations
Intrafetal laser treatment for twin reversed arterial perfusion sequence: cohort study and
meta-analysis
Pagani et al., UOG 2013
13. Intrafetal laser treatment for twin reversed arterial perfusion sequence: cohort study and
meta-analysis
Pagani et al., UOG 2013
Discussion points
• What is the optimal surveillance strategy in pregnancies diagnosed with TRAP
sequence?
• Should elective intrafetal therapy routinely be performed in all cases of TRAP
sequence regardless of ultrasound findings?
• If so, what is the optimal gestational age for treatment?
• Would restricting the window of intrafetal laser treatment to 13-16 weeks’
gestation increase the risk of chorion-amnion separation?
• What is the optimal surveillance strategy post-procedure?
• Should care for TRAP pregnancies be centralized?
• What is the long-term neurologic outcome for the surviving co-twin following
intrafetal therapy for TRAP?