Dennis L G, Winkler C L
Prenatal Diagnostic Center, Carilion Center for Women and Children, Roanoke, VA, USA.
Am J Obstet Gynecol. 1997 Aug;177(2):342-7; discussion 347-9. doi: 10.1016/s0002-9378(97)70196-0.
Untreated twin-to-twin transfusion syndrome reportedly carries nearly a 100% mortality rate. Over the last decade a number of therapeutic modalities have been attempted, including aggressive amniocentesis. This study was a retrospective evaluation of a series of 22 patients with twin-to-twin transfusion syndrome referred to our prenatal diagnostic center to determine the effectiveness in treating twin-to-twin transfusion syndrome with aggressive therapeutic amniocentesis.
In this study three patients did not meet diagnostic criteria. For various reasons six patients did not have therapeutic amniocentesis done. One patient chose to terminate the pregnancy after three amniocenteses. Another patient chose to discontinue therapy after removal of just 100 ml of amniotic fluid. Of the 11 treated patients, the mean gestational age at diagnosis was 22 weeks 4 days (range 15 weeks 4 days to 26 weeks 4 days).
The mean number of amniocenteses done was 5.5 (range 1 to 12). The mean total of amniotic fluid removed over the course of the pregnancy was 8.0 L (range 1100 to 24,200 ml). The mean number of days gained in these pregnancies was 56 (range 9 to 125) compared with 54 days for the untreated women. Eighty-two percent of the treated fetuses survived compared with 50% in the untreated group. Newborns in the treated group were delivered at a later gestational age and weighed more than those in the untreated group.
Spontaneous resolution of twin-to-twin transfusion syndrome does occur. Therapeutic amniocentesis offers a simple, effective method of therapy for twin-to-twin transfusion syndrome.
据报道，未经治疗的双胎输血综合征死亡率接近100%。在过去十年中，人们尝试了多种治疗方法，包括积极的羊膜腔穿刺术。本研究对转诊至我们产前诊断中心的22例双胎输血综合征患者进行了回顾性评估，以确定积极的治疗性羊膜腔穿刺术治疗双胎输血综合征的有效性。
在本研究中，3例患者不符合诊断标准。由于各种原因，6例患者未进行治疗性羊膜腔穿刺术。1例患者在进行3次羊膜腔穿刺术后选择终止妊娠。另1例患者在仅抽出100 ml羊水后选择停止治疗。在11例接受治疗的患者中，诊断时的平均孕周为22周4天（范围为15周4天至26周4天）。
平均进行羊膜腔穿刺术的次数为5.5次（范围为1至12次）。整个孕期抽出的羊水总量平均为8.0 L（范围为1100至24200 ml）。与未治疗的孕妇相比，这些妊娠的平均孕周增加天数为56天（范围为9至125天），未治疗孕妇为54天。接受治疗的胎儿82%存活，未治疗组为50%。治疗组新生儿的分娩孕周较晚，体重也高于未治疗组。
双胎输血综合征确实会自然缓解。治疗性羊膜腔穿刺术为双胎输血综合征提供了一种简单、有效的治疗方法。
