Mahieu-Caputo D, Salomon L J, Le Bidois J, Fermont L, Brunhes A, Jouvet P, Dumez Y, Dommergues M
Maternité, Hôpital Necker-Enfants Malades, AP-HP and Université Paris V, Paris, France.
Prenat Diagn. 2003 Aug;23(8):640-5. doi: 10.1002/pd.652.
To investigate if systemic hypertension occurs in fetuses with twin-to-twin transfusion syndrome (TTTS).
We conducted an observational cohort study in a tertiary care centre in 23 pregnant women with TTTS. Polyhydramnios stuck twin sequence occurred at a median gestational age of 22 weeks (range 15-27). Biventricular myocardial hypertrophy was diagnosed in 22/23 recipient fetuses. In cases with atrioventricular valve regurgitation (AVR), it was possible to estimate the fetal systolic systemic blood pressure by ultrasound, on the basis of the simplified Bernouilli equation. The diagnosis of fetal hypertension (FHT) was made when the estimated systolic arterial pressure was equal to or above 1.6-fold the expected value.
In 10 pregnancies (group A), fetal blood pressure could be assessed in recipients with AVR. The maximum velocities ranged from 2.9 to 5 m/s, leading to estimates of systemic fetal arterial pressure from 37 to 104 mmHg, that is, 1.6- to 2.8-fold the expected values. In 13 pregnancies (group B), fetal blood pressure could not be assessed in the absence of AVR. In group A, perinatal death (16/20) and hydrops (7/20) were significantly more frequent than in group B (8/26 and 1/26 respectively).
Fetal systemic hypertension may occur in recipient twins and could play a role in the pathophysiology of TTTS.
研究双胎输血综合征（TTTS）胎儿是否会发生全身性高血压。
我们在一家三级护理中心对23例TTTS孕妇进行了一项观察性队列研究。羊水过多黏附双胎序列发生的中位孕周为22周（范围15 - 27周）。23例受血胎儿中有22例被诊断为双心室心肌肥厚。对于存在房室瓣反流（AVR）的病例，可根据简化的伯努利方程通过超声估计胎儿收缩期体循环血压。当估计的收缩期动脉压等于或高于预期值的1.6倍时，诊断为胎儿高血压（FHT）。
在10例妊娠（A组）中，可对存在AVR的受血胎儿进行血压评估。最大流速范围为2.9至5米/秒，导致估计的胎儿体循环动脉压为37至104毫米汞柱，即预期值的1.6至2.8倍。在13例妊娠（B组）中，由于不存在AVR，无法评估胎儿血压。A组围产期死亡（16/20）和水肿（7/20）的发生率显著高于B组（分别为8/26和1/26）。
受血双胎可能会发生胎儿全身性高血压，并且可能在TTTS的病理生理过程中起作用。
