Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA.
Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
Ultrasound Obstet Gynecol. 2020 Apr;55(4):489-495. doi: 10.1002/uog.20298.
To evaluate infant survival according to the Doppler pattern of impedance to blood flow in the umbilical arteries (UAs) prior to laser surgery, in pregnancies with twin-to-twin transfusion syndrome (TTTS).
This was a retrospective study of women with a monochorionic diamniotic twin pregnancy who underwent laser surgery for TTTS between January 2012 and May 2018 at a single institution. Absolute intertwin difference in UA pulsatility index (DUAPI) was measured within 48 h prior to laser surgery. Twins with intermittent or persistent absent/reversed end-diastolic flow (EDF) in the UA (UA-EDF) were analyzed separately. Survival of both or at least one infant at birth and at 30 days postpartum was compared between pregnancies with an intertwin DUAPI of ≥ 0.4 and those with an intertwin DUAPI of < 0.4, as well as between fetuses with intermittent and those with persistent absent/reversed UA-EDF. Parametric and non-parametric tests were used for analysis. Regression analysis was performed to determine if intertwin DUAPI and intermittent or persistent absent/reversed UA-EDF were associated independently with infant survival, while controlling for gestational age at delivery, Quintero stage and other important confounding variables.
Of 231 TTTS pregnancies that underwent laser surgery during the study period, UA Doppler information could be retrieved for 206 and delivery information was available for 184, which comprised the study population. Rates of double-twin survival at birth were significantly higher in pregnancies with an intertwin DUAPI of < 0.4 than in those with an intertwin DUAPI of ≥ 0.4 (83.9% (78/93) vs 50.0% (12/24); P < 0.001). Double-infant survival at birth was higher in pregnancies with intermittent compared to those with persistent absent/reversed UA-EDF (73.0% (27/37) vs 36.7% (11/30); P = 0.003). Regression analysis demonstrated that an intertwin DUAPI of < 0.4 was associated with increased survival of both twins at delivery (P < 0.001) and at 30 days postpartum (P = 0.002), as well as increased survival of at least one twin at delivery (P = 0.009). Similarly, intermittent absent/reversed UA-EDF was associated with increased survival of both twins at delivery (P = 0.007) and at 30 days after birth (P = 0.015).
Evaluation of intertwin differences in UA impedance to blood flow as well as identification of intermittent or persistent absent or reversed UA-EDF prior to laser surgery could help in the prediction of double-infant survival at birth and to 30 days in twin pregnancies with TTTS. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
评估双胞胎输血综合征（TTTS）孕妇在激光手术前脐动脉（UA）血流阻抗的多普勒模式与婴儿存活率之间的关系。
这是一项回顾性研究，纳入了 2012 年 1 月至 2018 年 5 月期间在单家机构接受激光手术治疗 TTTS 的单绒毛膜双羊膜囊双胎妊娠女性。在激光手术前 48 小时内测量 UA 搏动指数（UA-PI）的双胎间绝对差值（DUAPI）。将 UA 存在间歇性或持续性无/反向舒张末期血流（UA-EDF）（UA-EDF）的胎儿分为两组分别进行分析。比较 DUAPI 为≥0.4 和<0.4 的双胎妊娠以及 UA-EDF 为间歇性和持续性无/反向的胎儿的两组在分娩时和产后 30 天时的双胎存活率。分析采用参数和非参数检验。进行回归分析以确定 DUAPI 和 UA-EDF 的间歇性或持续性无/反向与婴儿存活率是否存在独立相关性，同时控制分娩时的胎龄、Quintero 分期和其他重要混杂变量。
在研究期间接受激光手术的 231 例 TTTS 妊娠中，可获取 206 例 UA 多普勒信息，184 例可获得分娩信息，这些信息构成了研究人群。DUAPI<0.4 的双胎妊娠的分娩时双胎存活率明显高于 DUAPI≥0.4 的双胎妊娠（83.9%（78/93）比 50.0%（12/24）；P<0.001）。UA-EDF 为间歇性的双胎妊娠的分娩时双胎存活率高于 UA-EDF 为持续性无/反向的双胎妊娠（73.0%（27/37）比 36.7%（11/30）；P=0.003）。回归分析表明，DUAPI<0.4 与分娩时双胎存活率增加相关（P<0.001），产后 30 天存活率增加相关（P=0.002），以及至少有一胎存活率增加相关（P=0.009）。同样，UA-EDF 间歇性无/反向与分娩时双胎存活率增加相关（P=0.007），以及产后 30 天存活率增加相关（P=0.015）。
在激光手术前评估 UA 血流阻抗的双胎间差异，以及识别 UA-EDF 的间歇性或持续性无/反向，可能有助于预测 TTTS 双胎妊娠的分娩时和产后 30 天的双胎存活率。版权所有 © 2019 ISUOG。由 John Wiley & Sons Ltd 出版。
