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La fetoscopia por síndrome de transfusión feto fetal es la cirugía fetal más realizada en el mundo. Los resultados deben ser reportados, para que las pacientes puedan elegir su opción de atención. Objetivo: Determinar los resultados de cirugía fetal en el síndrome de transfusión feto-fetal. Diseño: Estudio retrospectivo. Lugar: Clínica Alemana, Santiago, Chile. Participantes: Gestantes con gemelares. Intervenciones: La cirugía fetal se realizó con anestesia local, endoscopios Storz de 3,3 mm, específicos para fetoscopia. Principales medidas de resultados: Sobrevida fetal. Resultados: La serie de casos se inició en el año 2005, y hasta la fecha se han realizado 71 cirugías, con 69 que han resuelto su embarazo. Treinta y tres mujeres tuvieron ambos hijos vivos (48%), 25 solo un hijo vivo (36%) y 11 concluyeron sin hijos vivos (16%). Conclusiones: La tasa de embarazos con uno o ambos niños vivos fue 84%, superando 90% en los últimos 30 casos. Hubo 6 pacientes de Perú, de las cuales cuatro tuvieron ambos hijos vivos.
Fetoscopy for fetal-fetal transfusion syndrome is the most frequent fetal surgery performed in the world. The results should be reported, so that the patients can choose their choice of care. Objective: To determine the results of fetal surgery on twin-to-twin transfusion syndrome. Design: Retrospective study. Setting: Clínica Alemana, Santiago, Chile. Participants: Pregnant women with twins. Interventions: Fetal surgery was performed under local anesthesia, with 3.3mm fetoscopy-specific Storz endoscopes. Main outcome measures: Fetal survival. Results: The series of cases began in the year 2005, and to date 71 surgeries were carried out, with 69 that resolved their pregnancy. Thirty-three women had both living children (48%), 25 only one living child (36%) and 11 concluded without living children (16%). Conclusions: The rate of pregnancies with one or both children born alive was 84%, exceeding 90% in the last 30 cases. There were 6 patients from Peru, of which four had two living children.
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Objective To evaluate the perinatal outcome of three types of monochorionic diamniotic (MCDA) twins with selective intrauterine growth restriction (sIUGR).Methods From January 2005 to June 2012,clinical data of 42 pairs of MCDA twins (84 fetuses) with sIUGR and 71 pairs of normal MCDA twins (142 fetuses) in the same period were analyzed retrospectively in the First Affiliated Hospital of Sun Yat-Sen University.Fetuses with sIUGR were classified into three groups based on umbilical artery Doppler flow.There were 25 cases of type Ⅰ,11 cases of type Ⅱ and 6 cases of type Ⅲ.The perinatal outcome was compared between sIUGR and normal MCDA twins,and among the three types of sIUGR as well.Perinatal outcomes included gestational age at delivery,rate of intrauterine fetal death (IUFD),birth weight,intertwin discordance of birth weight,neonatal death and survival rate at 6 months.Results (1) The gestational age of sIUGR at delivery was significantly earlier than the control group [(34 ± 3),(36 ±2) weeks,respectively],and the rate of IUFD of both fetuses of sIUGR was significantly higher (4.8％,0,respectively).In the sIUGR group,the average birth weight of large or small twins[(2130 ±.350),(1520 ±400) g,respectively] was smaller than those in the control group [(2470 ± 500),(2340 ± 460) g,respectively].The difference was statistically significant (P ＜ 0.05,P ＜ 0.01,respectively).The intertwin discordance of birth weight in sIUGR group was significantly larger (27.6％) than the control group(4.0％,P＜0.01).(2) The gestational age at delivery in type Ⅱ and type Ⅲ [(34 ±5),(34 ±2) weeks,respectively] was significantly earlier than the control group (P ＜ 0.05).The rate of IUFD of both fetuses in type Ⅱ (18％) was significantly higher than in type Ⅰ (0) and the control group (0,P ＜ 0.05).In sIUGR group,the average birth weight of small twins in type Ⅰ,type Ⅱ and type Ⅲ was (1640 ±430),(1330 ±310) and (1500 ±380) g respectively,all of which were significantly smaller than that in the control group (P ＜ 0.05).The average birth weight of small twins in type Ⅱ was smaller than in type Ⅰ and the difference was statistically significant (P ＜ 0.05).In sIUGR group,the intertwin discordance of birth weight in type Ⅰ,type Ⅱ and type Ⅱ was 24.1％,34.6％,31.3％ respectively,all of which were significantly larger than that in the control group(4.0％,P ＜ 0.05).There were no statistically significant differences of the intertwin discordance of birth weight among the three types of sIUGR(P ＞0.05).Survival rate at 6 months in type Ⅱ (64％) was significantly lower than in type Ⅰ (92％) and the control group (91.5％,P＜0.01).Conclusions The perinatal outcome of MCDA twins with sIUGR is poor.The outcome is different among the three types of sIUGR,and type Ⅰ is the worst.Type Ⅱ is associated with a high risk of intrauterine fetal demise.It is important to monitor the intrauterine situation closely.
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Objective To study the placental vascular distribution of monochorionic (MC) twins with twin-to-twin transfusion syndrome (TTTS) or hirth weight discordance.Methods Twenty-eight MC placentas were injected in Peking University Third Hospital between Feb.2010 and Feb.2011.The vascular distribution type (parallel,crossed,mixed and monoamniotic),the anastomosis of vessels and the placental sharing were recorded.The outcome of pregnancy and the placental characteristics of birth weight discordance (birth weight discordance ≥ 20％) in non-TTTS MC twins were analyzed.Results (1) The outcome of pregnancy:the miscarriage or gestational weeks of 28 MC twins were 20 to 38 weeks (median of 35 weeks).Six cases were TTTS,3 of which received fetoscopic laser occlusion of communicating vessels (FLOC).There were 48 live births,with an average birth weight of (2036 ± 623) g.(2) Type of placental vascular distribution:in the 28 MC placentas,number of parallel,crossed,mixed and monoamniotic type of placental vascular distribution were 4 (14％),14 (50％),6 (21％) and 4 (14％) cases,respectively.No parallel type was found in TTTS.There was no significant difference of vascular anastomosis or unequal placental sharing among the different placental vascular distribution types (P ＞ 0.05).(3) Characteristics of placental vascular distribution in birth weight discordance twins:there were 20 non-TTTS MC twin pregnancies,all of which got live births of both babies.Birth weight discordance equal to or more than 20％ was found in 6 pairs of newborns,while birth weight discordance less than 20％ was found in the rest 14 cases.Ratio of unequal placental sharing was significantly different between the two groups (P ＜ 0.01).There was no significant difference of umbilical cord insertion,placental vascular distribution and anastomosis in the two groups (P ＞0.01).Conclusions Vascular distribution type of MC twins might be related to TTTS.Unequal placental sharing is a risk factor of birth weight discordance in non-TTTS MC twins.
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Objective To study the perinatal outcome of monochorionic (MC) twin pregnancies.Methods The 197 cases of MC twin pregnancies delivered in obstetric unit of Prince of Wales Hospital from Jan.2005 to Dec.2010 were enrolled in this retrospective study,which were divided into 3 groups:uncomplicated MC pregnancy (136 cases),twin to twin transfusion syndrome (TTTS,32 cases),selective intrauterine growth restriction (sIUGR,29 cases).Results (1)The gestational age at delivery in TTTS (30 weeks vs.37 weeks,P ＜0.01) or sIUGR (34 weeks vs.37 weeks,P ＜0.01) group were significantly lower than those in uncomplicated MC pregnancy.The number of live-born in TTTS (36 cases)or sIUGR (47 cases) group were significantly lower than those in uncomplicated MC pregnancy (261 cases,P ＜0.01).(2) The incidence of fetal death (IUFD) in TTTS [34％ (11/32) vs.4％ (6/136),P ＜0.01]or sIUGR group [28％ (8/29) vs.4％ (6/136),P ＜0.01] were significantly higher than those in uncomplicated MC pregnancy group.(3) The incidence of birth weight (BW) disc ordance ＞ 25％ in TTTS [5/15 vs.7.7％ (10/130),P ＜0.05] or sIUGR[33％ (7/21) vs.7.7％ (10/130),P ＜0.05] group were significantly higher than those in uncomplicated MC pregnancy group.(4) The incidence of preterm delivery before 37 weeks was 49％ (66/136) and 69％ (20/29) respectively in uncomplicated MC pregnancy and sIUGR.The incidence of preterm delivery in sIUGR group were significantly higher than that in uncomplicated MC pregnancy group (P ＜ 0.05).(5) The incidence of perinatal mortality in TTTS [12％(5/41) vs.0.4％ (1/262),P ＜0.01] or sIUGR[10％ (5/52) vs.0.4％ (1/262),P ＜0.01] group were significantly higher than those in uncomplicated MC pregnancy group.(6) The incidence of estimated fetal weight (EFW) discordance ＞25％ was 17％ (23/136) in uncomplicated MC pregnancy,52％ (15/29) in sIUGR,63％ (20/32) in TTTS.In uncomplicated MC pregnancy or sIUGR,pregnancies with EFW discordance ＞25％ was associated with lower gestational age at delivery,higher incidence of preterm delivery and admission to NICU than those with EFW discordance ≤ 25％ (P ＜ 0.05).In uncomplicated MC pregnancy,pregnancies with EFW discordance ＞ 25％ was associated with higher incidence of neonatal asphyxia (Apgar score 1 minute ≤7) than those with EFW discordance≤25％ (P ＜0.05).(7) Compared to uncomplicated MC pregnancy,the incidence of umbilical artery (UmA) flow abnormality was higher in TTTS[38％(12/32) vs.9.6％(13/136),P＜0.01]or sIUGR[41％(12/29) vs.9.6％(13/136),P＜0.01].The incidence of IUFD in pregnacies with UmA flow abnormality was 2/13,6/12 and 5/12 respectively in uncomplicated MC pregnancy,TTTS and sIUGR.Conclusions MC pregnancies complicated by either TTTS or sIUGR have poorer perinatal outcome as compared with uncomplicated MC pregnancies.MC pregnancies with EFW discordance ＞ 25％ and UmA flow abnormality are associated with even worse perinatal outcome.Close fetal monitoring is needed in MC pregnancies in order to reduce perinatal mortality.