羊膜腔镜激光凝固术治疗双胎输血综合征后医源性的羊膜绒毛膜分离和中隔切开术。

Iatrogenic chorioamniotic separation and septostomy following fetoscopic laser photocoagulation for twin-twin transfusion syndrome.

机构信息

Department of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA.

Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA.

出版信息

Ultrasound Obstet Gynecol. 2022 Apr;59(4):506-512. doi: 10.1002/uog.23723. Epub 2022 Mar 10.

DOI:10.1002/uog.23723

PMID:34182599

Abstract

OBJECTIVE

To compare the perinatal outcomes of pregnancies complicated by chorioamniotic separation (CAS) vs septostomy following fetoscopic laser photocoagulation (FLP) for twin-twin transfusion syndrome (TTTS).

METHODS

This was a retrospective cohort analysis of monochorionic diamniotic twin pregnancies with TTTS that underwent FLP at one of two university-affiliated tertiary medical centers between January 2012 and December 2020. CAS and septostomy were diagnosed either during the procedure or by ultrasonography within 24-48 h after FLP. Data on procedure and postprocedure parameters, pregnancy outcomes and survival were collected from the patients' electronic medical records. Pregnancies were stratified according to the presence of CAS, septostomy or neither. Patients diagnosed with both CAS and septostomy were analyzed separately.

RESULTS

Of the 522 women included in the cohort, 38 (7.3%) were diagnosed with CAS, 68 (13.0%) with septostomy and 23 (4.4%) with both CAS and septostomy. The remaining 393 (75.3%) women comprised the control group. Groups did not differ in demographic characteristics. The septostomy group had a lower rate of selective fetal growth restriction than did the CAS and control groups (24.2% vs 36.8% vs 42.7%, respectively; P = 0.017). Moreover, intertwin size discordance was lower in the septostomy group (15.1% vs 23.4% in the CAS group and 25.5% in the control group; P = 0.001). Median gestational age at FLP was significantly lower in the CAS group (19.3 weeks vs 20.4 weeks in controls and 20.9 weeks in the septostomy group; P = 0.049). The rate of delivery prior to 34 weeks was significantly higher in the CAS group (89.2%), followed by the septostomy group (80.9%), compared with the control group (69.0%) (P = 0.006). A secondary analysis demonstrated that patients with both CAS and septostomy presented the highest rates of delivery prior to 34 weeks (100%) and 32 weeks (68.2%).

CONCLUSIONS

CAS and septostomy following laser surgery for TTTS are independently associated with higher rates of preterm delivery. The presence of these two findings in the same patient enhances the risk of prematurity. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

摘要

目的

比较羊膜腔分离（CAS）与胎儿镜激光凝固术后行中隔切开术（septostomy）对双胎输血综合征（TTTS）患者围产期结局的影响。

方法

这是一项回顾性队列分析，纳入了 2012 年 1 月至 2020 年 12 月在两家大学附属三级医疗中心接受胎儿镜激光凝固术治疗的单绒毛膜双羊膜囊双胎妊娠患者。在手术过程中或术后 24-48 小时内通过超声检查诊断出 CAS 和 septostomy。从患者的电子病历中收集了手术和术后参数、妊娠结局和存活率等数据。根据是否存在 CAS、septostomy 或两者均无，将妊娠分为三组。对同时诊断出 CAS 和 septostomy 的患者进行单独分析。

结果

在纳入的 522 名女性中，38 名（7.3%）诊断为 CAS，68 名（13.0%）诊断为 septostomy，23 名（4.4%）同时诊断为 CAS 和 septostomy。其余 393 名（75.3%）女性为对照组。各组间的人口统计学特征无差异。与 CAS 组和对照组相比，septostomy 组选择性胎儿生长受限的发生率较低（24.2% vs. 36.8% vs. 42.7%；P=0.017）。此外，septostomy 组的双胎间大小差异较小（15.1% vs. 23.4%在 CAS 组和 25.5%在对照组；P=0.001）。CAS 组行胎儿镜激光凝固术时的中位孕龄显著较低（19.3 周 vs. 对照组为 20.4 周和 septostomy 组为 20.9 周；P=0.049）。与对照组（69.0%）相比，CAS 组（89.2%）和 septostomy 组（80.9%）的更早分娩率（<34 周）显著更高（P=0.006）。二次分析表明，同时存在 CAS 和 septostomy 的患者更早分娩（<34 周，100%；<32 周，68.2%）的比例最高。