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双胎贫血-红细胞增多序列征:产前诊断的复杂目标,当前的知识现状

Twin anaemia polycythaemia sequence: a complicated target for prenatal diagnosis, a current state of knowledge.

作者信息

Alfoldi Martin, Kunochová Ivana, Gábor Martin, Ferianec Vladimír

机构信息

Medical Facutly of Comenius Medical Facutly of Comenius University, Bratislava, Slovakia, Slovakia.

出版信息

Ginekol Pol. 2022;93(9):742-749. doi: 10.5603/GP.a2021.0178. Epub 2022 Jan 24.

Abstract

OBJECTIVES

Processing of available information on TAPS with a focus on the evaluation of the most sensitive and most specific prenatal diagnostic test.

MATERIAL AND METHODS

Retrospective analysis of available publications on TAPS with their meta-analytical processing through available electronic medical databases. Evaluation of the most sensitive and specific prenatal diagnostic test with graphical processing of sensitivity and specificity values ​​depending on the TAPS diagnostic criteria used.

RESULTS

In total, we found 165 available articles, the oldest from 2007 and the most recent from 2020. Based on the available articles, we evaluated the determination of MCA-PSV with a sensitivity of 83% and a specificity of up to 100% for the currently generally accepted diagnostic criterion TAPS - Delta MCA-PSV > 0.5MoM as the most sensitive and specific method of prenatal diagnosis.

CONCLUSIONS

The serial determination of MCA-PSV represents the most sensitive and specific prenatal diagnostic test to date (2020) based on available knowledge. Serial measurement of the MCA-PSV since gestational week 20 every two weeks until delivery represents a potential TAPS screening test for all monochorionic pregnancies. The late, or postnatal diagnosis of TAPS can have serious consequences in the form of intrauterine death of the foetus(es) and increased perinatal mortality and morbidity.

摘要

目的

处理有关双胎输血综合征(TAPS)的现有信息,重点评估最敏感和最特异的产前诊断测试。

材料与方法

通过可用的电子医学数据库对有关TAPS的现有出版物进行回顾性分析及其荟萃分析处理。根据所使用的TAPS诊断标准,通过对敏感性和特异性值进行图形处理,评估最敏感和特异的产前诊断测试。

结果

我们总共找到了165篇可用文章,最早的发表于2007年,最新的发表于2020年。基于这些可用文章,对于目前普遍接受的诊断标准TAPS - 大脑中动脉搏动指数(MCA-PSV)差值>0.5倍中位数(Delta MCA-PSV > 0.5MoM),我们评估了MCA-PSV测定法,其敏感性为83%,特异性高达100%,是最敏感和特异的产前诊断方法。

结论

基于现有知识,MCA-PSV的系列测定是迄今为止(2020年)最敏感和特异的产前诊断测试。自妊娠20周起每两周进行一次MCA-PSV的系列测量直至分娩,对所有单绒毛膜双胎妊娠来说是一种潜在的TAPS筛查测试。TAPS的晚期诊断或产后诊断可能会导致严重后果,如胎儿宫内死亡以及围产期死亡率和发病率增加。

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