羊水过多患者羊膜腔内压力对接受羊膜腔镜激光手术治疗的双胎输血综合征患者宫颈长度的影响。
Effect of intra-amniotic fluid pressure from polyhydramnios on cervical length in patients with twin-twin transfusion syndrome undergoing fetoscopic laser surgery.
机构信息
The Texas Fetal Center, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Medical School, Houston, TX, USA.
Department of Anesthesiology, McGovern Medical School, Houston, TX, USA.
出版信息
Ultrasound Obstet Gynecol. 2019 Dec;54(6):774-779. doi: 10.1002/uog.20228.
OBJECTIVES
To determine the relationship between intra-amniotic pressure and cervical length (CL) in patients with twin-twin transfusion syndrome (TTTS) undergoing fetoscopic laser photocoagulation (FLP), and to identify pre- or intraoperative factors associated with increased intra-amniotic pressure in this population.
METHODS
This was a prospective cohort study of patients undergoing FLP for TTTS. Exclusion criteria were triplet or higher-order gestation and prior cervical cerclage, amnioreduction or FLP procedure. CL was assessed using preprocedure transvaginal ultrasound. Intra-amniotic pressure measurements were obtained on initial placement of the trocar into the amniotic cavity, using a direct hydrostatic pressure gauge. The relationship between intra-amniotic pressure and CL was assessed using multivariate linear regression analysis, including relevant preoperative and intraoperative variables.
RESULTS
In total, 283 pregnancies met the inclusion criteria. Quintero stage of TTTS was I in 33 pregnancies, II in 88, III in 150 and IV in 12. Mean gestational age (GA) at FLP was 20.7 ± 3 weeks. Mean intra-amniotic pressure was 23.1 ± 9 mmHg. On unadjusted linear regression analysis, there was no significant association between intra-amniotic pressure and preoperative CL (P = 0.24) or GA at delivery (P = 0.22). On multivariate analysis, the factors associated significantly with intra-amniotic pressure were: number of prior term deliveries (P = 0.03), recipient maximum vertical pocket (P < 0.0001), Quintero stage IV (P = 0.01) and type of anesthesia (sedation vs general anesthesia; P = 0.01).
CONCLUSION
In pregnancies with TTTS, intra-amniotic pressure is not associated with CL or GA at delivery. This novel finding suggests that cervical shortening in this population is not mechanically driven. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
目的
确定接受胎儿镜激光凝固术（FLP）治疗的双胎输血综合征（TTTS）患者羊膜内压力与宫颈长度（CL）之间的关系，并确定该人群中与羊膜内压力增加相关的术前或术中因素。
方法
这是一项对接受 TTTS 胎儿镜激光凝固术的患者进行的前瞻性队列研究。排除标准为三胎或更高胎次妊娠、先前行宫颈环扎术、羊水减量术或胎儿镜激光凝固术。CL 在术前经阴道超声检查进行评估。羊膜内压力测量在初次将套管针插入羊膜腔时使用直接液压计进行。使用多元线性回归分析评估羊膜内压力与 CL 之间的关系，包括相关的术前和术中变量。
结果
共 283 例妊娠符合纳入标准。TTTS 的 Quintero 分期为 I 期 33 例，II 期 88 例，III 期 150 例，IV 期 12 例。FLP 时的平均孕龄（GA）为 20.7±3 周。平均羊膜内压力为 23.1±9mmHg。在未调整的线性回归分析中，羊膜内压力与术前 CL（P=0.24）或分娩时 GA（P=0.22）之间无显著相关性。多元分析显示，与羊膜内压力显著相关的因素包括：既往足月分娩次数（P=0.03）、受者最大垂直囊袋深度（P＜0.0001）、Quintero 分期 IV 期（P=0.01）和麻醉类型（镇静 vs 全身麻醉；P=0.01）。
结论
在 TTTS 妊娠中，羊膜内压力与 CL 或分娩时 GA 无关。这一新发现表明，该人群的宫颈缩短不是机械驱动的。版权所有©2019 ISUOG。由 John Wiley & Sons Ltd 出版。
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