Mylrea-Foley Bronacha, Shaw Caroline J, Harikumar Nirupama, Legg Sophie, Meher Shireen, Lees Christoph C
Queen Charlotte's and Chelsea Hospital Imperial College Healthcare NHS Trust London UK.
Institute of Reproductive and Developmental Biology Imperial College London London W12 0HS UK.
Australas J Ultrasound Med. 2019 Aug 30;22(4):286-294. doi: 10.1002/ajum.12176. eCollection 2019 Nov.
Data on the outcomes of early-onset twin-twin transfusion syndrome (TTTS), diagnosed before 18 weeks gestational age (GA), are sparse. We aimed to review the diagnosis, management and outcomes of early-onset TTTS.
Pregnancy records at a single referral unit 2010-6 were reviewed. In early-onset TTTS cases, data for pregnancy characteristics, interventions and outcomes were collected. PubMed and Scopus databases were searched for studies including pregnant women with early-onset TTTS. The primary outcome measure was livebirths.
Case series: 58 cases of early-onset TTTS 2010-6, with full outcome data in 44. Diagnostic criteria were variable. Median GA at intervention was 17 (range 15-28); 67% of patients had laser therapy (39/58). Overall survival: 60% (53/88). At least one livebirth: 86% (38/44), Two livebirths: 34% (15/44); No survivors: 14% (6/44). GA at delivery was 32 (range 16-37). Systematic review: 16 studies included (n = 171 pregnancies). Diagnostic criteria varied widely: 79% of studies used Quintero staging. Most offered laser (89%) at median 17 weeks (range 16-21). GA at delivery was 23-39 weeks. Overall survival: 69% (129/186). At least one livebirth: 74% (127/171). Two livebirths: 59% (55/93). No survivors: 26% (44/171).
In comparison with the commonly accepted overall survival for TTTS treated after 18 weeks of 60-90%, outcomes in early-onset TTTS were at the lower bound of this range. Gestational age at intervention is similar to that of later onset TTTS, indicating a lack of therapeutic options when a diagnosis is made before 18 weeks.
关于孕龄18周前诊断的早发型双胎输血综合征（TTTS）结局的数据较少。我们旨在回顾早发型TTTS的诊断、管理及结局。
回顾了2010年至2016年单一转诊单位的妊娠记录。对于早发型TTTS病例，收集了妊娠特征、干预措施及结局的数据。检索了PubMed和Scopus数据库，查找包含早发型TTTS孕妇的研究。主要结局指标为活产。
病例系列：2010年至2016年有58例早发型TTTS，44例有完整结局数据。诊断标准不一。干预时的孕龄中位数为17周（范围15 - 28周）；67%的患者接受了激光治疗（39/58）。总体生存率：60%（53/88）。至少有一个活产：86%（38/44）；两个活产：34%（15/44）；无存活者：14%（6/44）。分娩时的孕龄为32周（范围16 - 37周）。系统评价：纳入16项研究（n = 171例妊娠）。诊断标准差异很大：79%的研究采用Quintero分期。大多数在孕龄中位数17周（范围16 - 21周）时提供激光治疗。分娩时的孕龄为23 - 39周。总体生存率：69%（129/186）。至少有一个活产：74%（127/171）。两个活产：59%（55/93）。无存活者：26%（44/171）。
与普遍接受的孕龄18周后治疗的TTTS总体生存率60% - 90%相比，早发型TTTS的结局处于该范围的下限。干预时的孕龄与晚发型TTTS相似，表明在孕龄18周前做出诊断时缺乏治疗选择。
