Mari G, Detti L, Levi-D'Ancona R, Kern L
Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, CT 06520-8063, USA.
J Perinatol. 1998 Sep-Oct;18(5):399-403.
To assess the fetal outcome, in a tertiary center, in pregnancies with suspected twin-to-twin transfusion syndrome (TTTS) not confirmed using ultrasonographic examination, diagnosis of pathology, or both.
Forty-four pregnancies with suspected TTTS were followed longitudinally using ultrasonographic examination until delivery. The minimal criteria for the diagnosis of TTTS were: (1) suspicion of monochorionicity gleaned from ultrasound examination (to be confirmed at birth); (2) presence of polyhydramnios in one gestational sac (either assessed subjectively--or, finding that the largest vertical pocket of amniotic fluid was >8 cm in diameter before 20 weeks' gestation and >10 cm in diameter thereafter); and (3) presence of oligohydramnios in the other gestational sac (finding either that there was a "stuck" twin complication or that the largest vertical pocket of amniotic fluid was <1 cm in diameter). When one of the above criteria was not present, the pregnancy was defined as "pseudo" TTTS. Fetal outcome in "pseudo" TTTS was analyzed according to the relative size of the neonate (large or small) and whether the cord insertion was normal or velamentous.
There were 18 cases of "pseudo" TTTS. No treatment in utero was necessary in any of the 18 pregnancies. The mean gestational age was 21.9 +/- 3.7 (1 SD) weeks at diagnosis and 33.0 +/- 3.0 weeks at delivery. The average weight discrepancy between the twins at birth was 34.3 +/- 14.8%. There were three fetal demises of the small twin and one neonatal demise of the large twin (p > 0.05). Large twins developed respiratory distress syndrome (RDS) more often than small twins (p < 0.05). Five percent of the large twins and 50% of the small twins had a velamentous insertion of the cord (p < 0.05).
In pregnancies complicated by "pseudo" TTTS our data indicate that: (1) small twins have abnormal cord insertion more frequently than large twins, (2) large twins develop RDS more frequently than small twins. Our data suggest that the perinatal mortality in these pregnancies appears to be lower than that reported for the classical TTTS.
在一家三级医疗中心，评估超声检查未确诊、未进行病理诊断或两者均未进行时，疑似双胎输血综合征（TTTS）的妊娠的胎儿结局。
对44例疑似TTTS的妊娠进行纵向超声检查直至分娩。TTTS诊断的最低标准为：（1）超声检查提示单绒毛膜性（出生时确诊）；（2）一个羊膜囊出现羊水过多（主观评估——或发现妊娠20周前羊水最大垂直深度直径>8 cm，20周后直径>10 cm）；（3）另一个羊膜囊出现羊水过少（发现有“黏附”双胎并发症或羊水最大垂直深度直径<1 cm）。当上述标准之一不存在时，该妊娠定义为“假性”TTTS。根据新生儿相对大小以及脐带插入是否正常或帆状，分析“假性”TTTS的胎儿结局。
有18例“假性”TTTS。18例妊娠中均无需宫内治疗。诊断时平均孕周为21.9±3.7（1标准差）周，分娩时为33.0±3.0周。出生时双胞胎之间的平均体重差异为34.3±14.8%。小双胎有3例胎儿死亡，大双胎有1例新生儿死亡（p>0.05）。大双胎比小双胎更常发生呼吸窘迫综合征（RDS）（p<0.05）。5%的大双胎和50%的小双胎脐带为帆状插入（p<0.05）。
在合并“假性”TTTS的妊娠中，我们的数据表明：（1）小双胎脐带插入异常比大双胎更频繁；（2）大双胎发生RDS比小双胎更频繁。我们的数据表明，这些妊娠的围产期死亡率似乎低于经典TTTS报道的死亡率。
