Taylor M J O, Govender L, Jolly M, Wee L, Fisk N M
Centre for Fetal Care, Department of Maternal and Fetal Medicine, Imperial College of Science, Technology and Medicine, Queen Charlotte's and Chelsea Hospital, London, United Kingdom.
Obstet Gynecol. 2002 Dec;100(6):1257-65. doi: 10.1016/s0029-7844(02)02392-x.
To validate an established staging system for twin-twin transfusion syndrome.
Prospective observational study in a tertiary referral fetal medicine center of 52 consecutive cases of twin-twin transfusion syndrome. Each pregnancy was assessed longitudinally for a variety of prognostic factors including fetal biometry, amniotic fluid volume, arterial and venous Doppler sonogram abnormalities, and the presence of hydrops. Data were used to determine stage at diagnosis and first treatment, and worst stage throughout pregnancy. Perinatal outcome was assessed by stage. Management comprised serial amnioreduction, septostomy, selective reduction, or delivery, alone or in combination.
Median gestation at presentation and first treatment were both 21 weeks (range 14-34 and 15-34), and at delivery it was 29 weeks (range 16-40). Sixty-three percent of pregnancies (33 of 52) were at least stage III at presentation. Forty-five percent of pregnancies (22 of 49) progressed to a more advanced stage. Overall survival was 47% (47 of 100), with no difference between donor and recipient fetuses (40% [20 of 50] versus 54% [27 of 50] [chi(2) P =.5]). Survival rates were 58% (15 of 26), 60% (six of ten), 42% (20 of 48), 43% (six of 14), and 0% (none of two) for stages I-V, respectively, with no significant influence of stage at presentation on survival. Survival was poorer where stage increased, versus decreased (27% [12 of 44] versus 94% [17 of 18] chi(2) P <.001). Kaplan-Meier survival curves indicated that staging at presentation identified pregnancies at greater risk of earlier rather than later gestational perinatal loss.
The Quintero staging system did not distinguish good from bad outcome at presentation, and thus should be used with caution in guiding initial management of twin-twin transfusion syndrome. However, prognosis was influenced by a change in stage, and pregnancies progressing to higher stage disease were at increased risk of earlier perinatal loss. Staging may thus be more useful in monitoring disease progression.
验证一种已确立的双胎输血综合征分期系统。
在一家三级转诊胎儿医学中心对52例连续的双胎输血综合征病例进行前瞻性观察研究。对每一妊娠进行纵向评估，观察多种预后因素，包括胎儿生物测量、羊水量、动脉和静脉多普勒超声异常以及水肿情况。数据用于确定诊断和首次治疗时的分期以及整个孕期的最严重分期。根据分期评估围产期结局。处理措施包括单纯或联合进行系列羊膜腔穿刺减压、隔膜造口术、选择性减胎或分娩。
就诊时和首次治疗时的孕周中位数均为21周（范围14 - 34周和15 - 34周），分娩时为29周（范围16 - 40周）。63%的妊娠（52例中的33例）就诊时至少为Ⅲ期。45%的妊娠（49例中的22例）进展至更高级别分期。总体存活率为47%（100例中的47例），供体和受体胎儿之间无差异（40%[50例中的20例]对54%[50例中的27例][χ² P = 0.5]）。Ⅰ - Ⅴ期的存活率分别为58%（26例中的15例）、60%（10例中的6例）、42%（48例中的20例）、43%（14例中的6例）和0%（2例中无存活），就诊时的分期对存活率无显著影响。分期增加时的存活率低于分期降低时（27%[44例中的12例]对94%[18例中的17例]χ² P < 0.001）。Kaplan - Meier生存曲线表明，就诊时的分期可识别出孕周较早而非较晚发生围产期死亡风险更高的妊娠。
Quintero分期系统在就诊时无法区分预后好坏，因此在指导双胎输血综合征的初始处理时应谨慎使用。然而，预后受分期变化的影响，进展至更高分期疾病的妊娠发生早期围产期死亡的风险增加。因此，分期在监测疾病进展方面可能更有用。
