Wang Xueju, Wei Yuan, Yuan Pengbo, Zhao Yangyu
Department of Obstetrics & Gynecology, Peking University Third Hospital, Beijing 100191, China.
Department of Obstetrics & Gynecology, Peking University Third Hospital, Beijing 100191, China; Email:
Zhonghua Yi Xue Za Zhi. 2015 May 5;95(17):1323-7.
To explore the prevalence, number and size of anastomoses, placenta sharing and placental cord insertion in twin-to-twin transfusion syndrome (TTTS).
A total of 97 monochorionic placentas were collected from June 2013 to June 2014 during fetoscopic laser surgery or selective feticide. After eliminating 23 placentas of selective intrauterine growth restriction (sIUGR), 79 placents were analyzed. There were 24 placentas of TTTS and 32 placentas of normal monochorionic twins (McT) without complex twin preganancy. Placental sharing, placental cord insertion, angioarchitecture and diameter of vascular anastomosis were assessed by placental injection with colored dye and compared between TTTS and McT without complex twin preganancy.
(1) Arterio-arterial (AA) anastomoses were detected in 37.5% of TTTS placentas versus 75.0% in normal McT placentas (P<0.01). (2) The median number of AA anastomoses in TTTS group was significantly less than that in normal group (0.0 vs 1.0, P<0.01). And the median total diameter of AA anastomoses in TTTS group was significantly smaller than that in normal group (0.00 vs 2.25 mm, P<0.01). (3) The incidence of placentas with at least one cord non-central insertion (70.8% vs 62.5%, P>0.05), velamentous insertion (25.0% vs 6.3%, P>0.05) in TTTS and normal McT had no difference respectively. The placental territory discordance (PTD) had no difference between TTTS and normal McT (0.33 vs 0.22, P>0.05).
AA anastomosis occurs less frequently in TTTS placentas, supporting the concept of a protective role of AA anastomoses in TTTS. McT placentas without AA anastomosis have high risk for TTTS. The compensatory ablitiy of AA anastomosis may determine the time of TTTS onset. Non-central or velamentous cord insertion, placental sharing discordance are not risk factors for TTTS.
探讨双胎输血综合征（TTTS）中吻合口的发生率、数量和大小、胎盘共享及胎盘脐带插入情况。
2013年6月至2014年6月期间，在胎儿镜激光手术或选择性减胎术中收集了97个单绒毛膜胎盘。剔除23个选择性胎儿生长受限（sIUGR）的胎盘后，对79个胎盘进行分析。其中有24个TTTS胎盘和32个无复杂双胎妊娠的正常单绒毛膜双胎（McT）胎盘。通过向胎盘注射彩色染料评估胎盘共享、胎盘脐带插入、血管构筑及血管吻合口直径，并在TTTS组和无复杂双胎妊娠的McT组之间进行比较。
（1）37.5%的TTTS胎盘检测到动脉-动脉（AA）吻合口，而正常McT胎盘为75.0%（P<0.01）。（2）TTTS组AA吻合口的中位数显著少于正常组（0.0对1.0，P<0.01）。且TTTS组AA吻合口的总直径中位数显著小于正常组（0.00对2.25mm，P<0.01）。（3）TTTS组和正常McT组中至少有一处脐带非中央插入的胎盘发生率（70.8%对62.5%，P>0.05）、帆状插入发生率（25.0%对6.3%，P>0.05）分别无差异。TTTS组和正常McT组之间的胎盘范围不一致性（PTD）无差异（0.33对0.22，P>0.05）。
AA吻合口在TTTS胎盘中的发生率较低，支持AA吻合口在TTTS中起保护作用的观点。无AA吻合口的McT胎盘发生TTTS的风险较高。AA吻合口的代偿能力可能决定TTTS的发病时间。脐带非中央或帆状插入、胎盘共享不一致不是TTTS的危险因素。
