van den Wijngaard Jeroen P H M, Lopriore Enrico, van der Salm Sandra M A, Schaap Arty H P, Vandenbussche Frank P H A, Deruiter Marco C, van Gemert Martin J C
Laser Center, Academic Medical Center, University of Amsterdam, The Netherlands.
Prenat Diagn. 2007 Mar;27(3):233-9. doi: 10.1002/pd.1652.
Our objective was to identify the clinical consequences of deep-hidden anastomoses that occur underneath the placental surface.
Twelve placentae that underwent intrauterine laser ablation of placental anastomoses for twin-twin transfusion syndrome (TTTS) and 14 non-TTTS controls were investigated for deep-hidden anastomoses. Additionally, we investigated the inter-twin haemoglobin differences as an indicator for fetofetal transfusion. Placentae were divided into four groups: TTTS placentae without residual chorionic-plate anastomoses without deep-hidden anastomoses (group 1) and with deep-hidden anastomoses (group 2), and non-TTTS placentae with chorionic-plate anastomoses without deep-hidden anastomoses (group 3) and with deep-hidden anastomoses (group 4).
Deep-hidden anastomoses were identified in 58% (7/12) of the TTTS placentae after laser surgery and in 64% (9/14) of the non-TTTS placentae. Groups 1 and 2 had equal inter-twin haemoglobin differences: medians 1.4 and 1.2 gr/dL, respectively (p = 0.48). In group 3, the median inter-twin haemoglobin difference without deep-hidden anastomoses was 2.6 gr/dL (group 3) and with deep-hidden anastomoses (group 4) it was 5.1 gr/dL (p = 0.26).
Both comparisons imply that deep-hidden anastomoses did not cause any additional increase in Hb difference. In conclusion, haematological and additional hemodynamical analysis show that deep-hidden anastomoses are likely to occur without any clinical consequences.
我们的目的是确定胎盘表面下方发生的深部隐匿性吻合的临床后果。
对12例因双胎输血综合征（TTTS）接受宫内激光消融胎盘吻合术的胎盘和14例非TTTS对照胎盘进行深部隐匿性吻合的研究。此外，我们研究了双胎间血红蛋白差异作为胎儿-胎儿输血的指标。胎盘分为四组：无残留绒毛膜板吻合且无深部隐匿性吻合的TTTS胎盘（第1组）和有深部隐匿性吻合的TTTS胎盘（第2组），以及有绒毛膜板吻合且无深部隐匿性吻合的非TTTS胎盘（第3组）和有深部隐匿性吻合的非TTTS胎盘（第4组）。
激光手术后，58%（7/12）的TTTS胎盘和64%（9/14）的非TTTS胎盘发现有深部隐匿性吻合。第1组和第2组的双胎间血红蛋白差异相等：中位数分别为1.4和1.2 gr/dL（p = 0.48）。在第3组中，无深部隐匿性吻合的双胎间血红蛋白差异中位数为2.6 gr/dL（第3组），有深部隐匿性吻合的（第4组）为5.1 gr/dL（p = 0.26）。
这两个比较都表明深部隐匿性吻合不会导致血红蛋白差异进一步增加。总之，血液学和其他血液动力学分析表明，深部隐匿性吻合很可能在没有任何临床后果的情况下发生。
