Bruner J P, Crean D M
Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tenn. 37232-2519, USA.
Fetal Diagn Ther. 1999 Mar-Apr;14(2):80-5. doi: 10.1159/000020894.
To measure acute and chronic changes in the placenta and amniotic fluid associated with performance of decompression amniocentesis in pregnancies with the twin oligohydramnios-polyhydramnios sequence (TOPS).
Amniotic fluid pressures, placental thickness, placental perfusion, and amniotic fluid volumes were measured in each sac of a monochorionic diamniotic twin gestation before and after decompression amniocentesis. Indigo carmine was injected into the polyhydramnic sac after decompression, and fluid from the oligohydramnic sac was sampled after equilibration. Spectrophotometric analysis of amniotic fluid specimens was performed for dye detection. Amniotic fluid volume and placental perfusion studies were repeated 1 week later.
Three patients with TOPS were enrolled, and decompression amniocentesis was performed in the midtrimester. After decompression, amniotic fluid volume decreased in the polyhydramnic sac, amniotic fluid pressures decreased in both sacs, placental thickness increased, and umbilical artery Doppler velocimetry was unaffected. The amniotic fluid volume increased acutely in only one oligohydramnic sac after decompression, and ultrasonographic examination, amniotic fluid spectrophotometric analysis, and placental pathologic examination all identified interfetal membrane disruption as the etiology.
Decompression amniocentesis as a treatment for TOPS does not result in acute or chronic changes in the amniotic fluid volume of the oligohydramnic sac in the absence of interfetal membrane disruption.
测量与双胎羊水过少-羊水过多序列征（TOPS）妊娠行减压羊膜腔穿刺术相关的胎盘和羊水的急性及慢性变化。
在单绒毛膜双羊膜囊双胎妊娠的每个羊膜腔内，于减压羊膜腔穿刺术前后测量羊水压力、胎盘厚度、胎盘灌注及羊水量。减压后向羊水过多的羊膜腔内注入靛胭脂，待平衡后从羊水过少的羊膜腔内取样。对羊水标本进行分光光度分析以检测染料。1周后重复测量羊水量及胎盘灌注情况。
纳入3例TOPS患者，于孕中期行减压羊膜腔穿刺术。减压后，羊水过多的羊膜腔内羊水量减少，两个羊膜腔内的羊水压力均降低，胎盘厚度增加，脐动脉多普勒血流测定未受影响。减压后仅一个羊水过少的羊膜腔内羊水量急性增加，超声检查、羊水分光光度分析及胎盘病理检查均确定胎儿间膜破裂为病因。
对于TOPS，在胎儿间膜未破裂的情况下，减压羊膜腔穿刺术不会导致羊水过少羊膜腔内羊水量出现急性或慢性变化。
