Greimel Patrick, Klaritsch Philipp, Simonis Holger, Csapó Bence, Pohl Maximilian, Schneditz Daniel
Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria.
Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria.
J Clin Med. 2020 Jul 2;9(7):2085. doi: 10.3390/jcm9072085.
Twin-to-twin transfusion syndrome (TTTS) in monochorionic-diamniotic twin pregnancies usually requires fetoscopic laser ablation (FLA) followed by amniodrainage (AD). Perioperative maternal hemodynamic changes and hemodilution have been observed. Little is known about the underlying pathophysiology. We aimed to evaluate the impact of high volume amniodrainage on intrauterine pressure, placental thickness and maternal blood characteristics. A total of 18 cases of TTTS were included in this prospective pilot study. All patients were treated with FLA and subsequent AD. Intrauterine pressure and placental thickness were assessed before, during and after amniodrainage. Maternal hemoglobin, hematocrit and serum albumin were measured at admission and 24 h after the intervention. Amniodrainage led to a decrease in mean intrauterine pressure (from 30.1 ± 8.1 mmHg to 17.6 ± 3.6 mmHg ( < 0.001)) and an increase in mean placental thickness (from 16.8 ± 6.4 mm to 31.83 ± 8.64 mm ( < 0.001)). There was a positive correlation between changes in placental thickness and the amount of amniodrainage during intervention (Pearson's Rho 0.73; = 0.001). Hematocrit decreased from 33.4 ± 3.8 (%) to 28.4 ± 3.5 (%), i.e., an increase in relative blood volume by 18 ± 10.2% ( < 0.001). Albumin decreased from 37.9 ± 0.9 g/L to 30.7 ± 2.2 g/L, i.e., an increase in relative plasma volume by 24 ± 8.1% ( < 0.001). Amniodrainage leads to uterine decompression, increased placental thickness and subsequent maternal hemodilution. We propose the term "amniodrainage-induced circulatory dysfunction" for these specific maternal hemodynamic changes in the treatment of twin-to-twin transfusion syndrome.
单绒毛膜双羊膜囊双胎妊娠中的双胎输血综合征（TTTS）通常需要进行胎儿镜激光消融术（FLA），随后进行羊水减量术（AD）。围手术期观察到母体血流动力学变化和血液稀释。对其潜在病理生理学知之甚少。我们旨在评估大量羊水减量对子宫内压力、胎盘厚度和母体血液特征的影响。本前瞻性试点研究共纳入18例TTTS病例。所有患者均接受了FLA及后续的AD治疗。在羊水减量术前、术中和术后评估子宫内压力和胎盘厚度。在入院时及干预后24小时测量母体血红蛋白、血细胞比容和血清白蛋白。羊水减量导致平均子宫内压力降低（从30.1±8.1 mmHg降至17.6±3.6 mmHg（<0.001）），平均胎盘厚度增加（从16.8±6.4 mm增至31.83±8.64 mm（<0.001））。干预期间胎盘厚度变化与羊水减量量之间存在正相关（Pearson相关系数0.73；P = 0.001）。血细胞比容从33.4±3.8（%）降至28.4±3.5（%），即相对血容量增加18±10.2%（<0.001）。白蛋白从37.9±0.9 g/L降至30.7±2.2 g/L，即相对血浆容量增加24±8.1%（<0.001）。羊水减量导致子宫减压、胎盘厚度增加及随后的母体血液稀释。我们针对双胎输血综合征治疗中这些特定的母体血流动力学变化提出“羊水减量诱导的循环功能障碍”这一术语。
