Wax J R, Blakemore K J, Blohm P, Callan N A
Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, Md.
Fetal Diagn Ther. 1991;6(3-4):126-31. doi: 10.1159/000263636.
Until the recent introduction of therapeutic amniocentesis, pregnancies complicated by the stuck twin phenomenon usually suffered poor outcomes. We report the first case in which a single amniocentesis of the cotwin was followed by equalization of amniotic fluid volume in both sacs, resolution of nonimmune hydrops in the cotwin, and delivery of 2 healthy infants. The cause of the phenomenon in this was most likely severe twin-twin transfusion, based on a negative hematologic and serologic immune and nonimmune hydrops evaluation, and placental histology revealing a superficial large-caliber arteriovenous anastomosis joining the twins' circulations without an intervening capillary bed. The mechanism proposed for the physiologic response in this case to therapeutic amniocentesis is based on the correction of abnormal amniotic fluid volumes and pressures. This contention is supported by histologic evaluation of the placenta and the intrapartum fetal heart rate tracing.
在最近引入治疗性羊膜腔穿刺术之前，因双胎交锁现象而并发的妊娠通常预后不佳。我们报告了首例病例，对其中一个胎儿进行单次羊膜腔穿刺后，两个羊膜囊内的羊水量达到平衡，交锁胎儿的非免疫性水肿消退，最终分娩出两名健康婴儿。基于血液学、血清学免疫及非免疫性水肿评估结果为阴性，且胎盘组织学检查显示连接双胎循环的表浅大口径动静脉吻合处无中间毛细血管床，此病例中该现象的原因很可能是严重的双胎输血。针对此病例中治疗性羊膜腔穿刺术产生生理反应所提出的机制，是基于对异常羊水量和压力的纠正。胎盘的组织学评估及产时胎儿心率监测结果支持了这一观点。
