Duryea Elaine L, Happe Sarah K, McIntire Donald D, Dashe Jodi S
a Department of Obstetrics and Gynecology , University of Texas Southwestern Medical Center , Dallas , TX , USA.
J Matern Fetal Neonatal Med. 2016 Nov;29(21):3411-5. doi: 10.3109/14767058.2015.1131263. Epub 2016 Jan 14.
To describe the natural history of expectantly managed twin-twin transfusion syndrome (TTTS) specific to disease stage.
This was a retrospective study of monochorionic diamniotic pregnancies diagnosed with TTTS and delivered between 1997 and 2013. Staging was based on Quintero's criteria, with sonogram images reviewed to confirm findings specific to stage. Progression and outcomes were evaluated in pregnancies that did not receive any form of therapy.
Thirty-eight pregnancies were diagnosed with TTTS and delivered at our institution, representing 1.6 per 10 000 births. Twenty were expectantly managed, of which 50% were stage I at presentation. Progression occurred in 45% of pregnancies, including 50% initially diagnosed with stage I TTTS. Seventy percent of pregnancies experienced survival of at least one twin, with no stillbirths or neonatal deaths if TTTS resolved. Pregnancies in which TTTS was either stable or improved had higher overall survival, compared with pregnancies that experienced progression, 86% versus 22%, p < 0.001, as well as more frequent survival of one or both twins, 91% versus 44%, p = 0.02.
Among expectantly managed pregnancies with TTTS, most had early disease at diagnosis. Although 45% of cases progressed, which conferred poor prognosis, the majority experienced disease stabilization or improvement.
描述期待治疗的双胎输血综合征（TTTS）特定疾病阶段的自然病程。
这是一项对1997年至2013年间诊断为TTTS并分娩的单绒毛膜双羊膜囊妊娠进行的回顾性研究。分期基于昆特罗标准，回顾超声图像以确认特定阶段的发现。对未接受任何形式治疗的妊娠的病情进展和结局进行评估。
38例妊娠在我们机构被诊断为TTTS并分娩，占每10000例出生中的1.6例。20例接受期待治疗，其中50%在就诊时为I期。45%的妊娠发生病情进展，包括最初诊断为I期TTTS的妊娠中的50%。70%的妊娠至少有一个胎儿存活，如果TTTS得到缓解则无死产或新生儿死亡。与病情进展的妊娠相比，TTTS病情稳定或改善的妊娠总体存活率更高，分别为86%和22%，p<0.001，单胎或双胎存活的频率也更高，分别为91%和44%，p=0.02。
在接受期待治疗的TTTS妊娠中，大多数在诊断时为早期疾病。尽管45%的病例病情进展，预后较差，但大多数病例病情稳定或改善。
