Predictive model for preterm premature rupture of membranes following fetal endoscopy laser coagulation in twin-to-twin transfusion syndrome surgery

Abstract

Objective: To develop a risk prediction model for preterm premature rupture of membranes (PPROM) after fetal endoscopy laser coagulation (FLC) for Twin-to-Twin Transfusion Syndrome (TTTS), identifying related influencing factors. Methods: A retrospective analysis was conducted on 414 parturients from six Chinese hospitals treated with FLC for TTTS between January 2016 and January 2025. Patients were divided into non-occurrence (n = 263) and occurrence groups (n = 151) based on PPROM during pregnancy. Logistic regression identified predictors, establishing the risk prediction model. Results: Univariate and multivariate logistic analyses revealed postoperative amniotic fluid leakage, operation time, and intraoperative amniotic fluid reduction rate as risk factors, while preoperative cervical canal length and Trocar insertion distance from the internal cervical OS were associated with reduced risk (all P < 0.05). ROC curve analysis showed an area under the curve of 0.802 (95% CI: 0.700–0.904), indicating good predictive efficacy. The goodness-of-fit test (P = 0.165 > 0.05) confirmed model fit, and calibration curves demonstrated acceptable accuracy. Clinical decision curves indicated net benefit. Conclusion: This model, incorporating postoperative amniotic fluid leakage, operation time, intraoperative amniotic fluid reduction rate, preoperative cervical canal length, and Trocar insertion distance, effectively predicts PPROM risk after FLC for TTTS. It can assess risks clinically and guide interventions to prolong pregnancy and improve outcomes.