双极 cord 电凝术在复杂性单绒毛膜性双胎妊娠中的选择性胎儿减灭术：单中心连续 118 例。

Bipolar cord coagulation for selective feticide in complicated monochorionic twin pregnancies: 118 consecutive cases at a single center.

机构信息

Department of Obstetrics and Gynecology, Children's Hospital V. Buzzi, Milan, Italy.

出版信息

Ultrasound Obstet Gynecol. 2012 Apr;39(4):407-13. doi: 10.1002/uog.11073.

DOI:10.1002/uog.11073

PMID:22173905

Abstract

OBJECTIVE

To review the experience of performing selective feticide with bipolar cord coagulation (BCC) in complicated monochorionic (MC) twin pregnancies at a single center.

METHODS

This was a retrospective analysis of BCC performed using 3-mm bipolar forceps under ultrasound control in cases complicated by twin-to-twin transfusion syndrome, selective growth restriction, discordant anomaly or twin reversed arterial perfusion sequence.

RESULTS

The series comprised 118 cases with a median gestational age at the time of the procedure of 22 (range, 16-30) weeks. There were 14 (12%) intrauterine deaths of the cotwin, eight (7%) miscarriages and one (1%) termination of pregnancy. When BCC was performed before 19 weeks of gestation, the rate of miscarriage was 45%, whereas it was 3% (P < 0.001) when BCC was performed after 19 weeks. Preterm prelabor rupture of membranes (PPROM) occurred in 45 (38%) cases. The median interval between BCC and PPROM was 4 (interquartile range, 2-9) weeks. In 15 (13%) cases, PPROM occurred within 2 weeks after the procedure. Median gestational age at delivery was 34 (range, 24-41) weeks. The median birth weight was 2103 (range, 480-3875) g. Neonatal death occurred in 11 (9%) cases, and two (2%) children had severe neurologic morbidity. The overall survival rate was 71% (84/118).

CONCLUSION

BCC is an effective procedure in complicated MC twin pregnancies for selective feticide or when one fetus is severely jeopardized and delivery is not yet an option. Better outcomes can be achieved when this procedure is performed after 19 weeks.

摘要

目的

回顾在单绒毛膜（MC）复杂双胎妊娠中，使用双极脐带电凝（BCC）进行选择性减胎的经验。

方法

这是一项回顾性分析，在超声引导下使用 3mm 双极钳对双胎输血综合征、选择性生长受限、不一致性畸形或双胎反向动脉灌注序列等复杂病例进行 BCC。

结果

该系列包括 118 例，手术时的中位孕龄为 22（范围 16-30）周。有 14 例（12%）的同胎胎儿宫内死亡，8 例（7%）流产，1 例（1%）终止妊娠。当 BCC 在 19 周之前进行时，流产率为 45%，而在 19 周之后进行时为 3%（P<0.001）。45 例（38%）发生早产胎膜早破（PPROM）。BCC 和 PPROM 之间的中位间隔为 4（四分位间距，2-9）周。在 15 例（13%）病例中，PPROM 在手术后 2 周内发生。分娩时的中位孕龄为 34（范围 24-41）周。中位出生体重为 2103（范围 480-3875）g。新生儿死亡 11 例（9%），2 例（2%）儿童有严重神经系统并发症。总体存活率为 71%（84/118）。