Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Fetal Diagnostic Centers, Pasadena, CA, USA.
Ultrasound Obstet Gynecol. 2022 Dec;60(6):774-779. doi: 10.1002/uog.26041.
Twin-twin transfusion syndrome (TTTS) is characterized by unequal hemodynamics between the twins. We aimed to assess preoperatively the difference in umbilical vein flow (UVF) between the recipient and donor monochorionic diamniotic twins and evaluate the change in UVF following laser surgery in both twins.
This was a retrospective cohort study of differences in UVF that occurred following laser surgical treatment of TTTS. Sonographic assessment of the umbilical vein before and 24 h after fetoscopic laser surgery for TTTS was performed. Umbilical vein diameter and time-averaged maximum velocity were measured, and UVF per kg (UVF/kg) was converted into a Z-score by a calculator created using gestational age as an independent variable. Z-score values were converted into centiles, which were evaluated statistically. Median differences in UVF/kg centile values were adjusted for TTTS stage and presence of arterioarterial anastomoses.
The study population consisted of 363 TTTS patients. The adjusted preoperative median difference in UVF/kg centile between the recipient vs donor twin was 17.9% (-17.1% to 57.6%), P < 0.0001. The adjusted median difference in UVF/kg centile between the postoperative vs preoperative period among recipients was 2.2% (-10.8% to 13.8%), P < 0.0001, while the adjusted median difference among donors was 27.3% (8.2%-34.6%), P < 0.0001.
The preoperative difference in UVF between the recipient and donor twins confirms the pathophysiology of TTTS. Postoperatively, the substantial increase in UVF of the donor twin and the relatively small increase in UVF of the recipient twin confirm that ablation of the vascular communications resulted in rapid improvement in perfusion of the donor twin. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
双胎输血综合征（TTTS）的特征是双胞胎之间的血液动力学不均等。本研究旨在评估接受和供体单绒毛膜双羊膜 TTTS 双胞胎之间的脐静脉血流（UVF）差异，并评估激光手术后双胞胎之间的 UVF 变化。
这是一项回顾性队列研究，比较了 TTTS 激光治疗后 UVF 的差异。对 TTTS 胎儿镜激光手术后的脐静脉进行超声评估。测量脐静脉直径和时间平均最大速度，并通过以胎龄为自变量的计算器将 UVF/kg 转换为 Z 分数。Z 分数值转换为百分位数，并进行统计学评估。调整 TTTS 分期和存在动静脉吻合后，调整 UVF/kg 百分位数的中位数差异。
研究人群包括 363 例 TTTS 患者。接受者与供体双胞胎之间 UVF/kg 百分位的调整术前中位数差异为 17.9%（-17.1%至 57.6%），P<0.0001。接受者中术后与术前 UVF/kg 百分位的调整中位数差异为 2.2%（-10.8%至 13.8%），P<0.0001，而供者中为 27.3%（8.2%-34.6%），P<0.0001。
接受者与供体双胞胎之间术前 UVF 的差异证实了 TTTS 的病理生理学。术后，供体双胞胎的 UVF 显著增加，而接受者双胞胎的 UVF 相对增加较小，证实了血管吻合的消融导致供体双胞胎的灌注迅速改善。©2022 年作者。超声在妇产科由约翰威立父子公司代表国际妇产科超声学会出版。
