Résumé
Twin-twin transfusion syndrome is the specific complication in monochorionic diamnionic twin pregnancy with the higher morbidity and mortality.Now,the progress in the clinical manifestation,complications,diagnosis and treatment of the twin-twin transfusion syndrome are introduced,in order to arouse clinicians to put importance on the diagnosis of chorion and amnion,specially monochorion,and provide help for the early management and intervention of twin pregnancy.
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Objective To study the perinatal outcomes of monochorionic diamnionic ( MCDA ) twins.Method A retrospective study had been conducted to analyze the outcomes of MCDA twins delivered in Hospital from Jan 2011 to Dec 2012.According to whether complicated with twin to twin transfusion syndrome ( TTTS, n=14 ) and/or selective intrauterine growth restriction ( sIUGR, n=41 ) , the infants enrolled in the study were assigned into complicated group (n=55) and uncomplicated group (n=90).The infants with sIUGR were further subdivided into three groups .The outcomes of the neonates were compared between the groups.Result A total of 145 pairs of MCDA twins were delivered , 285 neonates (12 of them died after birth ) and 5 cases of stillbirth. The gestational age at delivery in complicated group were significantly lower than those in uncomplicated group (33.8 ±2.8weeks vs.35.5 ±1.6weeks, P<0.001);The birth weight in complicated group ( the birth weight of the bigger baby was 2072 ±460 g vs.2520 ± 383 g, the smaller one 1620 ±477 g vs.2320 ±373 g ) were significantly lighter than those in uncomplicated group;The incidence of fetal death in complicated MCDA twin pregnancies (7.3% vs.0) was significantly higher than controls .Neonatal outcomes of fetuses complicated with sIUGRⅠ ( n=23 ) were similar to controls.Neonates complicated with TTTS, sIUGRⅡ(n =6) or sIUGRⅢ (n =12) had significantly increased incidence of respiratory distress syndrome , asphyxia, cardiac disorders, retinopathy of prematurity and neonatal death compared with controls .Conclusion Neonates of MCDA with TTTS or sIUGR had more complications compared with uncomplicated MCDA twins .The fetuses with abnormal umbilical artery Doppler blood flow are more vulnerable to stillbirth , neonatal death and other serious adverse outcomes .
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Objective To evaluate retained fetal cardiovascular function after radio frequency ablation in complicated monochorionic diamnionic twins.Methods A total of 19 complicated monochorionic diamnionic twins [10 twin-twin transfusion syndrome (TTTS) and 9 selective intrauterine growth restricted (sIUGR)] who were diagnosed at Fetal Medicine Center of the First Affiliated Hospital of Sun Yat-Sen University from December 2013 to July 2015 were enrolled,and the cardiovascular profile score (CVPS) and Tei index of retained fetus were measured preoperatively and postoperatively at 24 h,3 days,1 week,1 month,2 months respectively.Each case was matched by normal fetuses with same gestational age as control group and the same parameters were measured.Results (1) TTTS:CVPS [(8.71 ± 1.11) scores] was increased significantly at 3 days postoperatively compared with preoperation [(6.86 ± 2.12) scores],and there was a statistical significance (t =2.571,P ＜ 0.05);CVPS [(9.29-± 0.95) scores] had no statistical significance 1 month postoperatively (P ＞ 0.05) as compared with controls [(10.00 ± 0.00) scores].Tei indexes of the left ventricle (LV-Tei) (0.41-± 0.06) and Tei indexes of the right ventricle (RV-Tei) (0.42 ± 0.06) decreased as compared with those before operation (LV-Tei:0.66 ± 0.19,RV-Tei:0.63 ± 0.12) with significant difference (LV:t =-3.193,P ＜ 0.05;RV:t =-3.565,P ＜ 0.05),but there was no statistical significance 1 month after operation(all P ＞ 0.05) as compared with the controls (LV-Tei:0.35-± 0.03,RV-Tei:0.35-± 0.03).(2) sIUGR:CVPS [(9.71 ± 0.45) scores] showed no statistical significance 1 week after operation (P ＞ 0.05) as compared with controls [(10.00 ± 0.00) scores].Tei indexes of the right and left ventricle 1 week after operation were lower than after operation with significant difference (LV-Tei:0.39 ± 0.04 vs.0.47 ± 0.06,t =-6.687,P ＜ 0.01;RV-Tei:0.38 ± 0.04 vs.0.47 ± 0.05,t =-6.000,P ＜ 0.01).Compared with the controls,RV-Tei (0.38 ± 0.04)had no statistical significance 1 week after operation (P ＞ 0.05),LV-Tei (0.36-± 0.02) showed no statistical significance 1 month after operation (P ＞ 0.05).Conclusions Retained fetal cardiovascular function of TTTS and sIUGR can be restored obviously after operation.In TTTS,its cardiovascular function is recovered completely 1 month postoperatively.In sIUGR,its cardiovascular function is recovered completely 1 week postoperatively.