Department of Obstetrics and Gynaecology, The National Maternity Hospital, Dublin, Ireland.
UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland.
Ir Med J. 2022 May 25;115(5):595.
Objective Twin to twin transfusion syndrome (TTTS) complicates 5-15% of monochorionic twin pregnancies and untreated is associated with a 90% mortality rate. The aim was to present the perinatal survival of patients with TTTS treated with laser ablation, by a national fetal medicine team. Methods This was a review of all cases of TTTS treated with fetoscopic laser ablation performed from March 2006 through to December 2020. All patients treated with fetoscopic laser were identified from the hospital database. The perinatal outcomes for the overall cohort and the individual Quintero stages were determined. Results A total of 155 cases of TTTS underwent fetoscopic laser ablation during the study period. The median gestational age at diagnosis was 19+1 weeks, with a mean growth discordance of 23.6%. The Quintero stage at diagnosis was: Stage 1 6.5% (10/155), Stage 2 49% (76/155), Stage 3 38.7% (60/155), Stage 4 5.8% (9/155). There was at least one survivor in 83.2% (129/155) of pregnancies, with dual survival in 52.9% (82/155). An increase in the rate of any survivor was observed from 75% (2006-2014) to 94% (2014-2020) (p<0.05). Dual survival decreased with increasing Quintero Stage (p<0.05). 80.6% (125/155) of pregnancies delivered prior to 34+6 weeks gestation. Conclusion Fetoscopic laser ablation is the recommended first line treatment for severe TTTS. We observed a survival rate of at least one twin in 83.2% pregnancies which is comparable to internationally published data on single-centre outcomes.
目的 双胎输血综合征（TTTS）在单绒毛膜双胎妊娠中占 5-15%，未经治疗的 TTTS 与 90%的死亡率相关。本研究的目的是介绍由国家胎儿医学团队用激光消融治疗 TTTS 的围产儿存活率。
方法 这是对 2006 年 3 月至 2020 年 12 月期间接受胎儿镜激光消融治疗的所有 TTTS 病例进行的回顾性研究。从医院数据库中确定所有接受胎儿镜激光治疗的患者。确定了整个队列和个体 Quintero 分期的围产儿结局。
结果 在研究期间，共有 155 例 TTTS 患者接受了胎儿镜激光消融术。诊断时的中位孕龄为 19+1 周，平均生长差异为 23.6%。诊断时的 Quintero 分期为：1 期 6.5%（10/155），2 期 49%（76/155），3 期 38.7%（60/155），4 期 5.8%（9/155）。在 83.2%（129/155）的妊娠中至少有一名存活儿，52.9%（82/155）的妊娠中存在双存活儿。从 2006 年至 2014 年，观察到任何存活儿的比率从 75%增加到 2014 年至 2020 年的 94%（p<0.05）。随着 Quintero 分期的增加，双存活儿的比例下降（p<0.05）。80.6%（125/155）的妊娠在 34+6 周前分娩。
结论 胎儿镜激光消融术是严重 TTTS 的首选一线治疗方法。我们观察到 83.2%的妊娠至少有一名存活儿，这与国际上发表的单中心结局数据相当。
