Ohkuchi A, Minakami H, Shiraishi H, Suzuki I, Ohki T, Sato I
Center for Perinatal Medicine and Department of Obstetrics and Gynecology, Jichi Medical School Hospital, Minamikawachi-machi, Tochigi, Japan.
Ultrasound Obstet Gynecol. 2002 Mar;19(3):293-6. doi: 10.1046/j.1469-0705.2002.00465.x.
Single intrauterine death may occur in twin-twin transfusion syndrome. We investigated why the outcome of the surviving twin is fairly good when the donor twin dies first compared with when the recipient twin dies first. A detailed hemodynamic study was performed using Doppler ultrasound in a twin pregnancy affected by twin-twin transfusion syndrome before and after a single intrauterine death that occurred in the donor twin at 26 weeks' gestation. The recipient twin was expected to die due to severe right cardiac failure with functional stenosis of the pulmonary artery 2 days before the cotwin's death. The donor twin's death caused a prompt resolution of cardiac failure and improvement in other indices, including flow velocity waveform patterns of the umbilical vein, the middle cerebral artery and the ductus venosus. A healthy, premature female neonate weighing 1630 g with a hemoglobin concentration of 17.8 g/dL was delivered by Cesarean section following rupture of the fetal membranes 28 days after the episode. Hemorrhaging from the surviving twin to the dead twin that occurred just before or after the cotwin's death may have contributed to the decrease in volume overload in the recipient twin, leading to a prompt amelioration of the critical hemodynamic indices. The early death of the donor twin may thus have played a significant role in improving the status of the recipient twin in this case of twin-twin transfusion syndrome.
单绒毛膜双胎输血综合征中可能会出现单胎宫内死亡。我们研究了在双胎输血综合征中，当供血胎儿先死亡与受血胎儿先死亡相比，存活胎儿的结局为何相当良好。在一例双胎输血综合征的双胎妊娠中，于孕26周时供血胎儿发生单胎宫内死亡前后，使用多普勒超声进行了详细的血流动力学研究。预计受血胎儿会在其双胎死亡前2天因严重的右心衰竭及肺动脉功能性狭窄而死亡。供血胎儿的死亡使心力衰竭迅速缓解，其他指标也有所改善，包括脐静脉、大脑中动脉和静脉导管的血流速度波形图。胎膜破裂28天后，通过剖宫产分娩出一名健康的早产女婴，体重1630g，血红蛋白浓度为17.8g/dL。在双胎死亡前后，存活胎儿向死亡胎儿的出血可能有助于减轻受血胎儿的容量超负荷，从而使关键血流动力学指标迅速改善。因此，在这例双胎输血综合征中，供血胎儿的早期死亡可能对改善受血胎儿的状况起到了重要作用。
