Department of Fetal Medicine and Ultrasound, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Acta Obstet Gynecol Scand. 2012 Oct;91(10):1201-5. doi: 10.1111/j.1600-0412.2012.01489.x. Epub 2012 Jul 24.
Monochorionic twin pregnancies are associated with increased risk of severe complications. Umbilical cord occlusion (UCO) and fetoscopic selective laser coagulation (FSLC) are used as invasive treatment. The study aim was to document treatment indications and pregnancy outcome where UCO and FSLC were used for treating fetal discrepancies and twin-to-twin transfusion syndrome (TTTS).
Cohort study of all consecutively treated monochorionic twin pregnancies 2004-2010.
Tertiary care center.
One hundred and twenty pregnancies treated by FSLC (55) or UCO (65). Umbilical cord occlusion was undertaken in 49 TTTS cases, in four cases with fetal abnormality and TTTS and in 12 cases because of fetal anomaly only.
Overall survival per fetus, survival per pregnancy of at least one fetus and further survival according to the Quintero stages. Infant survival until at least one week after birth.
Of the pregnancies studied, 84% had TTTS, 13% had a fetal malformation and 3% had both. Of TTTS cases, 69% were Quintero stage 3 and 4. In the UCO group with TTTS, 87% were in stage 3 and 4. Survival in the UCO group was 82%. In the laser group, the survival of at least one fetus was 85%. Overall survival per fetus was 60%.
By far the most common indication for invasive treatment was TTTS in Quintero stage 3. Outcome by means of survival after FSLC and UCO were similar to what has been reported elsewhere. Cord occlusion was an acceptable treatment alternative to fetoscopic selective laser coagulation in severe TTTS cases.
单绒毛膜双胞胎妊娠与严重并发症的风险增加有关。脐带闭塞（UCO）和胎儿镜下选择性激光凝固（FSLC）被用作侵入性治疗。本研究旨在记录治疗指征和妊娠结局，其中 UCO 和 FSLC 用于治疗胎儿差异和双胎输血综合征（TTTS）。
2004-2010 年连续治疗的单绒毛膜双胞胎妊娠队列研究。
三级保健中心。
120 例接受 FSLC（55 例）或 UCO（65 例）治疗的妊娠。UCO 用于 49 例 TTTS 病例，4 例胎儿异常和 TTTS 病例，12 例仅因胎儿异常。
每胎的总存活率、至少有一胎存活的妊娠存活率以及根据 Quintero 分期的进一步存活率。存活至出生后至少一周的婴儿存活率。
在所研究的妊娠中，84%有 TTTS，13%有胎儿畸形，3%两者都有。TTTS 病例中，69%为 Quintero 分期 3 和 4。在 UCO 组的 TTTS 病例中，87%为 3 和 4 期。UCO 组的存活率为 82%。在激光组中，至少有一个胎儿存活的比例为 85%。每胎的总存活率为 60%。
迄今为止，侵入性治疗最常见的指征是 Quintero 分期 3 的 TTTS。通过 FSLC 和 UCO 存活的结果与其他地方报道的结果相似。在严重 TTTS 病例中，脐带闭塞是胎儿镜下选择性激光凝固的一种可接受的治疗选择。
