Lemerle S, Le Vaillant C, Dubreil C, Boog G
Service de gynécologie-obstétrique, hôpital Mère-Enfant, 38, boulevard Jean-Monnet, 44035 Nantes cedex 01, France.
J Gynecol Obstet Biol Reprod (Paris). 2007 Dec;36(8):777-85. doi: 10.1016/j.jgyn.2007.05.011. Epub 2007 Jul 5.
Three cases of intermittent absent end-diastolic and reversed end-diastolic flow velocity (A/REDV) are reported in the proximal umbilical artery of the growth-retarded twin in monochorionic twin pregnancies. This typical doppler velocimetric pattern has been related to arterio-arterial anastomoses in two cases of intra-uterine growth retardation and in one case of twin-twin transfusion syndrome. According to the literature, superficial arterio-arterial anastomoses may be detected by doppler colour velocimetry in 75 to 85% of cases, while identification of arteriovenous connections is more difficult to be documented in vivo (50% of cases in experienced hands). The role of superficial vascular anastomoses, either arterio-arterial or venovenous, and that of deep arteriovenous communications is now well documented in the main complications of monochorionic pregnancies, particularly for twin-twin transfusion syndrome, intrauterine growth retardation, intrauterine fetal death and acardiac twins.
本文报告了3例单绒毛膜双胎妊娠中生长受限胎儿脐动脉近端出现间歇性舒张末期血流缺失及舒张末期血流反向（A/REDV）的情况。这种典型的多普勒测速模式在2例宫内生长受限及1例双胎输血综合征病例中与动脉 - 动脉吻合有关。根据文献，75%至85%的病例可通过多普勒彩色测速法检测到浅表动脉 - 动脉吻合，而在活体中记录动静脉连接则更困难（经验丰富者手中的病例为50%）。浅表血管吻合（动脉 - 动脉或静脉 - 静脉）以及深部动静脉交通在单绒毛膜妊娠的主要并发症中所起的作用，现已得到充分证实，尤其是在双胎输血综合征、宫内生长受限、宫内胎儿死亡及无心畸胎中。
