单绒毛膜单羊膜性双胎妊娠中双胎输血综合征的结局：系统评价和荟萃分析。
Outcome of twin-to-twin transfusion syndrome in monochorionic monoamniotic twin pregnancy: systematic review and meta-analysis.
机构信息
Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy.
Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK; and Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK.
出版信息
Ultrasound Obstet Gynecol. 2020 Mar;55(3):310-317. doi: 10.1002/uog.21889.
OBJECTIVES
To explore the outcome of monochorionic monoamniotic (MCMA) twin pregnancies affected by twin-to-twin transfusion syndrome (TTTS).
METHODS
MEDLINE and EMBASE databases were searched for studies reporting the outcome of MCMA twin pregnancies complicated by TTTS. The primary outcome was intrauterine death (IUD); secondary outcomes were miscarriage, single IUD, double IUD, neonatal death (NND), perinatal death (PND), survival of at least one twin, survival of both twins and preterm birth (PTB) before 32 weeks' gestation. Outcomes were assessed in MCMA twins affected by TTTS not undergoing intervention and in those treated with amniodrainage, laser therapy or cord occlusion. Subgroup analysis was performed including cases diagnosed before 24 weeks. Random-effects meta-analysis of proportions was used to analyze the data.
RESULTS
Fifteen cohort studies, including 888 MCMA twin pregnancies, of which 44 were affected by TTTS, were included in the review. There was no randomized trial comparing the different management options in MCMA twin pregnancies complicated by TTTS. In cases not undergoing intervention, miscarriage occurred in 11.0% of fetuses, while the incidence of IUD, NND and PND was 25.2%, 12.2% and 31.2%, respectively. PTB complicated 50.5% of these pregnancies. In cases treated by laser surgery, the incidence of miscarriage, IUD, NND and PND was 19.6%, 27.4%, 7.4% and 35.9%, respectively, and the incidence of PTB before 32 weeks' gestation was 64.9%. In cases treated with amniodrainage, the incidence of IUD, NND and PND was 31.3%, 13.5% and 45.7% respectively, and PTB complicated 76.2% of these pregnancies. Analysis of cases undergoing cord occlusion was affected by the very small number of included cases. Miscarriage occurred in 19.2%, while there was no case of IUD or NND of the surviving twin. PTB before 32 weeks occurred in 50.0% of these cases.
CONCLUSIONS
MCMA twin pregnancies complicated by TTTS are at high risk of perinatal mortality and PTB. Further studies are needed in order to elucidate the optimal type of prenatal treatment in these pregnancies. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
目的
探讨患有双胎输血综合征（TTTS）的单绒毛膜单羊膜（MCMA）双胎妊娠的结局。
方法
检索 MEDLINE 和 EMBASE 数据库中报道 MCMA 双胎妊娠合并 TTTS 病例结局的研究。主要结局为宫内死亡（IUD）；次要结局为流产、单 IUD、双 IUD、新生儿死亡（NND）、围产儿死亡（PND）、至少存活一胎、存活两胎和 32 周前早产（PTB）。评估未行干预的 TTTS 合并 MCMA 双胎妊娠以及行羊水引流、激光治疗或脐带结扎的胎儿结局。包括在 24 周前诊断的病例进行亚组分析。采用随机效应比例meta 分析对数据进行分析。
结果
共纳入 15 项队列研究，共 888 例 MCMA 双胎妊娠，其中 44 例合并 TTTS。没有随机试验比较 TTTS 合并 MCMA 双胎妊娠不同治疗方案的效果。未行干预的病例中，流产率为 11.0%，IUD、NND 和 PND 发生率分别为 25.2%、12.2%和 31.2%，50.5%的病例发生 PTB。激光手术治疗后，流产率、IUD、NND 和 PND 发生率分别为 19.6%、27.4%、7.4%和 35.9%，32 周前 PTB 发生率为 64.9%。羊水引流治疗后，IUD、NND 和 PND 发生率分别为 31.3%、13.5%和 45.7%，76.2%的病例发生 PTB。脐带结扎病例的分析受到纳入病例数量较少的影响。流产率为 19.2%，存活胎儿无一例发生 IUD 或 NND。50.0%的病例发生 32 周前 PTB。
结论
合并 TTTS 的 MCMA 双胎妊娠围产儿死亡率和 PTB 发生率高。需要进一步研究以明确此类妊娠的最佳产前治疗类型。
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