Mari G, Roberts A, Detti L, Kovanci E, Stefos T, Bahado-Singh R O, Deter R L, Fisk N M
Twin-Twin Transfusion Syndrome International Registry Group, Department of Obstetrics and Gynecology at University of Virginia, Charlottesville, USA.
Am J Obstet Gynecol. 2001 Sep;185(3):708-15. doi: 10.1067/mob.2001.117188.
Serial aggressive amnioreduction is the most widely used therapy for pregnancies that are complicated by twin-twin transfusion syndrome. Survival rates reported with this therapy are 33% to 83%, the wide range attributable to the small number of patients in these case series. Similarly, data on morbidity in survivors are imprecise. We instituted the international twin-twin transfusion syndrome registry to determine the perinatal survival and morbidity rates and the factors that influence perinatal outcome in patients with twin-twin transfusion syndrome who were treated with serial aggressive amnioreduction from 1990 to 1998.
A total of 223 sets of twins who were diagnosed with twin-twin transfusion syndrome before 28 weeks' gestation from 20 fetal medicine referral centers were analyzed, with follow-up data until 4 weeks after birth.
Three hundred forty-six twins (78%; 182 recipients and 164 donors) were born alive. Two hundred sixty-six twins (60%; 144 recipients and 122 donors) were alive 4 weeks after birth. Both fetuses survived to 4 weeks in 108 pregnancies (48.4%), whereas, at least 1 fetus survived in 158 pregnancies (70.8%). The interval between the last amnioreduction and delivery ranged from zero to 138 days (median, 17.5 days). In the infants who survived to 4 weeks after birth, abnormalities on neonatal cranial scan were diagnosed in 24% of recipients and in 25% of donors. Logistic regression analysis indicated that the survival rate was significantly related to gestational age at diagnosis, presence of end-diastolic blood flow in the umbilical artery velocity waveforms, presence of hydrops, mean volume of amniotic fluid removed per week, larger birth weight, and gestational age at delivery. The hemoglobin level difference at birth was the only significant parameter to predict abnormal cranial ultrasonography in newborns.
These data document perinatal survival and neonatal morbidity rates in severe twin-twin transfusion syndrome that were treated by serial aggressive amnioreduction. Outcome was influenced by several perinatal risk factors, which may be used to counsel patients before and during therapy.
连续进行积极羊膜腔减量术是治疗双胎输血综合征妊娠最常用的疗法。该疗法报告的存活率为33%至83%，这一较大范围归因于这些病例系列中的患者数量较少。同样，关于幸存者发病率的数据也不准确。我们设立了国际双胎输血综合征登记处，以确定1990年至1998年接受连续积极羊膜腔减量术治疗的双胎输血综合征患者的围产期存活率和发病率，以及影响围产期结局的因素。
对来自20个胎儿医学转诊中心、在妊娠28周前被诊断为双胎输血综合征的223对双胞胎进行了分析，并收集了直至出生后4周的随访数据。
346例双胞胎（78%；182例受血儿和164例供血儿）存活出生。266例双胞胎（60%；144例受血儿和122例供血儿）在出生后4周存活。108例妊娠（48.4%）中两个胎儿均存活至4周，而158例妊娠（70.8%）中至少有1个胎儿存活。最后一次羊膜腔减量术至分娩的间隔时间为0至138天（中位数为17.5天）。在出生后存活至4周的婴儿中，24%的受血儿和25%的供血儿经新生儿头颅扫描诊断有异常。逻辑回归分析表明，存活率与诊断时的孕周、脐动脉血流速度波形中舒张末期血流的存在、水肿的存在、每周抽取的羊水平均量、出生体重较大以及分娩时的孕周显著相关。出生时的血红蛋白水平差异是预测新生儿头颅超声检查异常的唯一显著参数。
这些数据记录了通过连续积极羊膜腔减量术治疗的严重双胎输血综合征的围产期存活率和新生儿发病率。结局受多种围产期危险因素影响，这些因素可用于在治疗前和治疗期间为患者提供咨询。
