Chimenea Ángel, García-Díaz Lutgardo, Antiñolo Guillermo
Department of Materno-Fetal Medicine, Genetics and Reproduction, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocio, CSIC, University of Seville, ES-41013 Seville, Spain.
Fetal, IVF and Reproduction Simulation Training Centre (FIRST), ES-41010 Seville, Spain.
Children (Basel). 2023 Jul 20;10(7):1250. doi: 10.3390/children10071250.
Twin-twin Transfusion Syndrome (TTTS) represents a significant complication in monochorionic twin pregnancies, caused by an unbalanced shunting of blood through intertwin placental vascular anastomoses. Despite advances in fetoscopic laser surgery, TTTS is still associated with a high rate of cerebral injury. However, there are no studies comparing these pregnancies with uncomplicated monochorionic diamniotic (MCDA) twin pregnancies, establishing the baseline risk of neurodevelopmental impairment. The aim of this study is to evaluate the odds of neurodevelopmental impairment in MCDA twins who undergo fetoscopic laser surgery for twin-twin transfusion syndrome, in comparison to a cohort of uncomplicated MCDA twin pregnancies.
This is a retrospective cohort study of children born from MCDA twin pregnancies at a single center between 2008 and 2019. A routine, standardized follow-up assessment was conducted at a minimum of 2 years after delivery. The primary outcome of this was a 2 year neurodevelopmental impairment. Neurological, motor, and cognitive development was assessed by using the revised Brunet-Lézine scale.
176 children met the enrolment criteria. Of these, 42 (24%; TTTS group) underwent fetoscopic laser surgery for TTTS during pregnancy, and 134 (76%; uncomplicated MCDA group) were uncomplicated MCDA pregnancies. The primary outcome was found in four children (9.52%) in the TTTS group and ten children (7.46%) in the uncomplicated MCDA group ( = 0.67, aOR 2.82, 95% CI 0.49-16.23). Major neurologic impairment was found in 2.38% after fetoscopic laser surgery and 1.49% in uncomplicated MCDA twins ( = 0.70, aOR 0.97, 95% CI 0.22-4.24). The data were adjusted by birth order, birth weight, and gestational age at birth.
The outcome in MCDA twins who underwent fetoscopic laser surgery for TTTS is comparable to the outcome in uncomplicated MCDA twins. Our findings emphasize the need for long-term neurodevelopmental follow-ups in all children from monochorionic twin gestations.
双胎输血综合征（TTTS）是单绒毛膜双胎妊娠的一种严重并发症，由双胎胎盘血管吻合处血液分流不均衡所致。尽管胎儿镜激光手术取得了进展，但TTTS仍与高脑损伤率相关。然而，尚无研究将这些妊娠与无并发症的单绒毛膜双羊膜囊（MCDA）双胎妊娠进行比较，以确定神经发育障碍的基线风险。本研究的目的是评估因双胎输血综合征接受胎儿镜激光手术的MCDA双胎与一组无并发症的MCDA双胎妊娠相比，神经发育障碍的几率。
这是一项对2008年至2019年在单一中心出生的MCDA双胎妊娠儿童进行的回顾性队列研究。在分娩后至少2年进行常规、标准化的随访评估。主要结局是2年神经发育障碍。使用修订的布鲁内-勒津量表评估神经、运动和认知发育。
176名儿童符合纳入标准。其中，42名（24%；TTTS组）在孕期因TTTS接受了胎儿镜激光手术，134名（76%；无并发症MCDA组）为无并发症的MCDA妊娠。TTTS组有4名儿童（9.52%）出现主要结局，无并发症MCDA组有10名儿童（7.46%）出现主要结局（P = 0.67，校正比值比2.82，95%可信区间0.49 - 16.23）。胎儿镜激光手术后2.38%出现严重神经损伤，无并发症MCDA双胎中为1.49%（P = 0.70，校正比值比0.97，95%可信区间0.22 - 4.24）。数据根据出生顺序、出生体重和出生时的孕周进行了调整。
因TTTS接受胎儿镜激光手术的MCDA双胎的结局与无并发症的MCDA双胎的结局相当。我们的研究结果强调了对所有单绒毛膜双胎妊娠儿童进行长期神经发育随访 的必要性。
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