采用不同标准化定义评估双胎输血综合征相关双胎贫血-红细胞增多症的围生期结局。

Perinatal outcomes of twin-to-twin transfusion syndrome associated with evidence of twin anemia polycythemia using different standardized definitions.

机构信息

Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA.

出版信息

Eur J Obstet Gynecol Reprod Biol. 2022 Dec;279:45-49. doi: 10.1016/j.ejogrb.2022.10.007. Epub 2022 Oct 12.

DOI:10.1016/j.ejogrb.2022.10.007

PMID:36244240

Abstract

OBJECTIVES

To evaluate the survival of twin-to-twin transfusion syndrome (TTTS) and concomitant twin anemia polycythemia sequence (TAPS) compared to TTTS without TAPS at the time of fetoscopic laser photocoagulation (FLP).

METHODS

TTTS pregnancies undergoing FLP were divided to three groups including (i) traditional TAPS definition of middle cerebral artery (MCA) peak systolic velocity (PSV) < 1 multiple of the median (MoM) in recipient and > 1.5 MoM in the donor fetus, (ii) delta MCA-PSV > 0.5 MoM and (iii) delta MCA-PSV > 1.0 MoM.

RESULTS

A total of 353 monochorionic twins underwent FLP for TTTS. Based on the traditional definition, 335 (94.9 %) had TTTS only and 18 (5.1 %) had TTTS + TAPS. There were 245 (69.4 %) TTTS only and 108 (30.6 %) TTTS + TAPS considering delta MCA-PSV > 0.5 MoM and 339 (96 %) TTTS only and 14 (4 %) TTTS + TAPS considering delta MCA-PSV > 1.0 MoM. No significant differences in survival were noted at birth or 30-days after delivery between TTTS and TTTS with TAPS patients using the traditional definition, delta > 0.5 MoM or delta > 1.0 MoM.

CONCLUSION

The rate of neonatal survival at birth or at 30-days of life following FLP for TTTS only and TTTS with TAPS were not different based on any of the clinically used TAPS definitions.

摘要

目的

评估在胎儿镜激光凝固术（FLP）时，双胎输血综合征（TTTS）伴发双胎贫血-红细胞增多序列症（TAPS）与单纯 TTTS 的存活率。

方法

将接受 FLP 的 TTTS 妊娠分为三组，包括：（i）传统 TAPS 定义为受血儿大脑中动脉（MCA）峰收缩速度（PSV）<1 个中位数倍数（MoM），供血儿 MCA-PSV>1.5 MoM；（ii）MCA-PSV 差值>0.5 MoM；（iii）MCA-PSV 差值>1.0 MoM。

结果

共有 353 例单绒毛膜双胞胎因 TTTS 接受了 FLP。根据传统定义，335 例（94.9%）为单纯 TTTS，18 例（5.1%）为 TTTS+TAPS。考虑到 MCA-PSV 差值>0.5 MoM，245 例（69.4%）为单纯 TTTS，108 例（30.6%）为 TTTS+TAPS；考虑到 MCA-PSV 差值>1.0 MoM，339 例（96%）为单纯 TTTS，14 例（4%）为 TTTS+TAPS。使用传统定义、delta>0.5 MoM 或 delta>1.0 MoM 时，TTTS 与 TTTS+TAPS 患者在出生时或出生后 30 天的存活率无显著差异。