Becker J, Hernandez-Andrade E, Muñoz-Abellana B, Acosta R, Cabero L, Gratacós E
Fetal Medicine Unit, Department of Obstetrics and Gynecology, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain.
Ultrasound Obstet Gynecol. 2006 Oct;28(5):674-80. doi: 10.1002/uog.2734.
To estimate changes in umbilical blood flow (UBF) and Doppler indices in pregnancies complicated by twin-to-twin transfusion syndrome (TTS) treated with either laser therapy or amniodrainage, and to evaluate the influence of the presence of hemodynamic deterioration prior to therapy, as determined by the Quintero stages of severity.
Forty-eight cases of TTS were included, and further classified into severity Stages I or II (absence of critically abnormal Dopplers (CAD), n = 22) and Stages III or IV (presence of CAD or hydrops fetalis, n = 26). In Stages I-II, 14 cases were treated with laser and eight with amniodrainage, and in Stages III-IV, 17 were treated with laser and nine with amniodrainage. Differences in the UBF, umbilical artery pulstility index (UA-PI) and ductus venosus pulsatility index (DV-PI) were estimated for both groups of severity before and after both treatments. Eleven normal monochorionic pregnancies were evaluated as controls.
In recipients, UBF was significantly higher with respect to controls regardless of the stage, while donors had a significant decrease in UBF, but only in Stages III-IV. After laser treatment no changes were observed in fetuses in Stages I-II. In Stages III-IV, recipients showed a significant reduction in the DV-PI (mean DV-PI 1.31 +/- 0.18 vs. 1.05 +/- 0.22; P = 0.005) whereas donors showed a significant increase in the UBF (mean UBF 134 +/- 36 mL/min vs. 195 +/- 25 mL/min; P < 0.001) and in the DV-PI (mean DV-PI 0.99 +/- 0.26 vs. 1.36 +/- 0.42; P = 0.002), and a reduction in the UA-PI (mean UA-PI 1.86 +/- 0.41 vs. 1.58 +/- 0.30; P = 0.01). After amniodrainage only donor fetuses in Stages III-IV showed an increase in UA-PI (mean UA-PI 1.54 +/- 0.35 vs. 1.72 +/- 0.40; P = 0.015). No other changes were observed in any of the parameters studied.
Laser therapy induces consistent hemodynamic variations in TTS mainly manifested in Stages III-IV.
评估接受激光治疗或羊水减量术治疗的双胎输血综合征（TTS）孕妇的脐血流（UBF）及多普勒指数变化，并根据Quintero严重程度分期评估治疗前血流动力学恶化情况的影响。
纳入48例TTS病例，并进一步分为严重程度I期或II期（无严重异常多普勒表现（CAD），n = 22）和III期或IV期（存在CAD或胎儿水肿，n = 26）。在I-II期，14例接受激光治疗，8例接受羊水减量术；在III-IV期，17例接受激光治疗，9例接受羊水减量术。评估两组严重程度在两种治疗前后的UBF、脐动脉搏动指数（UA-PI）和静脉导管搏动指数（DV-PI）差异。11例正常单绒毛膜妊娠作为对照。
在受血儿中，无论处于何期，UBF均显著高于对照组，而供血儿的UBF显著降低，但仅在III-IV期。激光治疗后，I-II期胎儿未观察到变化。在III-IV期，受血儿的DV-PI显著降低（平均DV-PI 1.31±0.18对1.05±0.22；P = 0.005），而供血儿的UBF显著增加（平均UBF 134±36 mL/min对195±25 mL/min；P < 0.001），DV-PI增加（平均DV-PI 0.99±0.26对1.36±0.42；P = 0.002），UA-PI降低（平均UA-PI
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