Mabuchi A, Ishii K, Yamamoto R, Taguchi T, Murata M, Hayashi S, Mitsuda N
Department of Maternal Fetal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan.
Ultrasound Obstet Gynecol. 2014 Sep;44(3):311-5. doi: 10.1002/uog.13343. Epub 2014 Jul 25.
To evaluate neonatal outcomes and clinical characteristics of monochorionic diamniotic (MCDA) twins with a large intertwin hemoglobin (Hb) difference at birth.
This was a retrospective cohort study of MCDA twin gestations delivered at Osaka Medical Center and Research Institute for Maternal and Child Health between 2003 and 2012. Cases of pregnancy termination, acardiac twins or intrauterine death were excluded. A large intertwin Hb difference at birth was defined as > 8.0 g/dL according to the postnatal criteria for twin anemia-polycythemia sequence (TAPS). The intertwin reticulocyte count ratio (RCR) was calculated by dividing the reticulocyte count of the anemic twin by that of the polycythemic twin. Cases with Hb differences were divided into two groups according to the RCR, TAPS when the RCR was > 1.7 and acute fetofetal hemorrhage (AFFH) when the RCR was ≤ 1.7. Neonatal outcomes were compared between the TAPS and AFFH groups.
During the study period, 432 MCDA twin pregnancies of a total of 532 born at our hospital were analyzed. There were 12 (2.8%) cases of a large intertwin Hb difference. The median gestational age at birth of these cases was 34 (range, 23-38) weeks, and all were delivered by Cesarean section. There were seven (1.6%) cases of TAPS and five (1.2%) of AFFH. The neonatal survival rate was 91.7%; in one pair of twins with TAPS neonatal death occurred. All (100%) cases with TAPS and two (40%) with AFFH required blood transfusion or partial-exchange transfusion for at least one infant.
Although the incidence of TAPS and AFFH may be low in MCDA twins, many affected neonates required treatment for hematological abnormalities. Delivery of MCDA twins via Cesarean section does not appear to prevent AFFH, despite the absence of labor.
评估出生时单绒毛膜双羊膜囊（MCDA）双胎间血红蛋白（Hb）差异较大时的新生儿结局及临床特征。
这是一项对2003年至2012年在大阪母婴健康医疗中心和研究所分娩的MCDA双胎妊娠进行的回顾性队列研究。排除终止妊娠、无心双胎或宫内死亡的病例。根据双胎贫血-红细胞增多序列（TAPS）的产后标准，出生时双胎间Hb差异较大定义为>8.0 g/dL。双胎间网织红细胞计数比值（RCR）通过将贫血双胎的网织红细胞计数除以红细胞增多双胎的网织红细胞计数来计算。根据RCR将Hb差异病例分为两组，RCR>1.7时为TAPS，RCR≤1.7时为急性胎儿-胎儿出血（AFFH）。比较TAPS组和AFFH组的新生儿结局。
研究期间，对我院出生的532例MCDA双胎妊娠中的432例进行了分析。有12例（2.8%）双胎间Hb差异较大。这些病例的出生孕周中位数为34（范围23 - 38）周，均通过剖宫产分娩。有7例（1.6%）TAPS病例和5例（1.2%）AFFH病例。新生儿存活率为91.7%；1例TAPS双胎发生新生儿死亡。所有（100%）TAPS病例和2例（40%）AFFH病例中至少有1名婴儿需要输血或部分换血治疗。
虽然MCDA双胎中TAPS和AFFH的发生率可能较低，但许多受影响的新生儿需要针对血液学异常进行治疗。尽管未临产，但通过剖宫产分娩MCDA双胎似乎并不能预防AFFH。
