急性双胎输血综合征一例

急性双胎输血综合征（TTTS）是单绒毛膜双胎妊娠极其罕见的并发症,其发生率占单绒毛膜双胎妊娠的1.5%~2.5%。本文报道了1例急性TTTS,并结合产前胎心监护、产后胎盘灌注以及文献复习,以期加深对于急性TTTS的认识。急性TTTS多发生于两胎儿脐带附着位置较近的病例,因此,孕期应加强对单绒毛膜双胎脐带附着位置的检查,...     

双胎输血综合征治疗1例

随着医学科学的发展，不断有新的诊断和治疗方法出现，对同一临床问题提出的解决方法可以迥然不同，有时甚至截然相反。如何找出真正有效的治疗方法，这是医生所必须解决的问题。运用循证医学的理念，得到有关诊断、诊疗、预防方面最好的证据，来解决我们日常碰到的临床问题。现将双胎输血综合征1例报告如下。     

羊水过多合并脐带畸形1例

患者25岁,住院号16188.因停经39周,不规律宫缩5小时于1989年6月8日入院.停经2个月时有早孕反应,近6个月来自觉胎动,妊娠33周时 B 超检查提示:羊水过多,疑胎儿消化道梗阻.查体:T36℃,P 80次/分,Bp 12.0/8.0kPa,Hb 100g/L,WBC 18.9×10~9/LN 0.80,L 0.20,肝功正常.宫高38cm,腹围101cm,左枕前位,胎心听不清,先露头     

双胎输血综合征合并镜像综合征引产一例

镜像综合征又称巴兰坦综合征,主要表现为胎儿、胎盘水肿和继发性母体不同程度的水肿及血液稀释的临床特点。镜像综合征发病率极低,病情进展快,国内外报道例数较少,目前其病因大多与诱发胎儿水肿的因素相关,其中双胎输血综合征是胎儿非免疫性水肿病因之一。回顾南京医科大学附属第一医院2019年2月收治的双胎输血综合征合并镜像综合征的病例,分析患者的一般情况,并予以合理治疗干预,分析预后情况。该患者在入院保守治疗的情况下病情加重,最终选择终止妊娠,妊娠终止后病情较前明显好转,予以出院门诊随访。现对其诊断、鉴别诊断和治疗方式进行讨论。     

消炎痛治疗双胎输血综合征患者羊水过多一例

消炎痛治疗双胎输血综合征患者羊水过多一例吴玉珍，盖铭英患者３０岁，孕１产０，月经周期正常，未次月经为１９９３年７月１９日。妊娠早期无特殊，孕５个月时，外院诊断双胎妊娠合并羊水过多，曾先后三次行羊膜腔穿刺，共抽出羊水４０００ｍｌ，因血红蛋白７４ｇ／Ｌ，...     

双胎输血综合征6例

双胎输血综合征(twin-twin transfusion syndrome,TTTS)由Herlitz于1941年首先发现,是单卵单绒毛膜双羊膜囊双胎妊娠的主要并发症,双胎中的发生率为5%,单绒毛膜双胎中的发生率为15%,偶见于双绒毛膜双胎。     

双胎输血综合征3例

双胎输血综合征（twin-twin transfusion syndrome，TTTS）是一种单卵双胎妊娠的严重并发症，发生在单绒毛膜双羊膜囊双胎，由于两个胎儿的血液循环在胎盘有血管相交通，故引起血液动力学差异。本文回顾性总结我院1996年7月-2004年11月收治的3例TTTS患者，分析其妊娠情况，围生期和远期结局，结合相关文献探讨TTTS的诊治方案。     

双胎输血综合征

双胎输血综合征多发生于单绒毛膜、单羊膜囊的单卵双胎,偶见于双绒毛膜、双羊膜囊的单卵双胎。已知单卵双胎系由一受精卵分裂而成。 1双胎的类型根据分裂发生在胚胎不同发育时期可出现以下4种情况。 1.1双绒毛膜、双羊膜单卵双胎:若受精卵的分裂发生在桑椹期或内细胞群已形成而囊胚之外层仍未发育成绒毛膜前,即在受精后72小时左右,则形成两个胚胎,两个羊膜囊及两个绒毛膜。分裂后两个独立的受精卵若着床位置相距较远,可形成各自独立的胎盘,     

双胎输血综合征

双胎输血综合征是一种围产儿死亡率较高并发症，诊断分为产前和产后诊断，及早的产前诊断和治疗能降低围产儿死亡率及患病率。     

双胎输血综合征

双胎输血综合征是指单合子单绒毛膜双羊膜囊双胎,在宫腔内一胎儿(供血儿)通过胎盘不平衡的血管吻合网将血液输送给另一胎儿(受血儿),而引起的一系列病理生理改变和,临床症状,是双胎或多胎妊娠的严重并发症.此病预后较差,很大程度上是源于其病因和病理生理还不十分清楚,以及临床上缺乏有效的治疗手段.目前诊断主要靠产前超声和产后胎儿、胎盘检查,现有的治疗方法较多,应用较多的是胎儿镜下选择性激光电凝、羊水减量、羊膜造口等,每种方法都有其优缺点和优选的时间,但为了改善该病的预后,还需在深入研究病因及病理生理的基础上,找出更合理可行的治疗方法.     

双胎输血综合征

双胎输血综合征(twin-twin transfusion syndrome, TTTs)是双胎妊娠中一种严重并发症，围产儿死亡率极高。以美国为例，估计每年约有2 200个胎儿死于TTTs［1］。现就80年代以来，有关TTTs的发生、诊断及处理综述如下:     

双胎输血综合征

双胎输血综合征是指双胎时由于胎盘上血管吻合,使两个胎儿间血流不均衡,一个胎儿(供血儿)发生贫血,另一胎儿(受血儿)导致多血症,因而在发育上出现明显的差异。本病严重影响两个胎儿的预后。一、病因及病理:本病只发生在一卵性双胎病例,由于血管吻合使血液供给偏于一方时始出现。单绒毛膜胎盘时,几乎所有病例均有血管吻合,而发生不同程度的血液转输现象。血管吻合有动脉-动脉、静脉-静脉、和动脉-静脉等三类,当动静脉吻合时,动脉侧胎儿则为供血者,静脉侧胎儿为受血者,血液流向一方。于是,供血儿发生贫血、发育不良、因尿量减少羊水也因之减少,有及因失     

双胎输血综合征

双胎输血综合征(twin-twin transfusion syndrome,TTTS)是一种特殊的双胎妊娠,它发生于单绒毛膜双羊膜囊(mono chrionic diamniotic twin,MCDA)双胎妊娠中,尽管近年来对其诊断、处理有了很大进展,     

双胎输血综合征

双胎输血综合征是发生于单卵单绒毛膜双胎的严重并发症。发病机制与胎盘血管吻合有关,一胎儿在子宫内通过胎盘血管吻合支将血液输送给另一胎儿,由于双胎间明显的血流动力学异常而引起一系列病理生理改变及临床表现。因其病因还不十分清楚,此病目前仍缺乏有效治疗方法,预后不佳。诊断主要依靠产前超声检查、产后胎儿检查、胎盘病理检查。目前应用较多的治疗方法是胎儿镜下选择性激光电凝、羊水减量等。为改善该病预后,还应深入研究病因以找出更有效的治疗方法。     

羊水减量术治疗双胎输血综合征的效果评价

Objective To find out the clinical outcomes of twin-twin transfusion syndrome (TTTS) after aminioreduction. Methods Twenty-nine pregnancies with TTTS delivered in Beijing Gynecological and Obstetric Hospital from Nov. 1, 2002 to Sept. 30, 2007 were recruited. The effect of gestational age at the onset, the degree of TTTS and amnioreduction therapy on the fetal outcomes were compared. Results All of the 8 cases with the onset of TTTS before 26 weeks without treat- ment were lost, but 4 out of the 6 with the onset after 26 weeks survived (P=0. 015). Among the 9 cases received amnioreduction, 4 out of the 5 with onset before 26 weeks survived, and significant difference was found compared to those untreated ones (P= 0. 007), but no difference was shown when compared with those developed after 26 weeks(4/4)(P= 1. 000). The average delivery weeks in the untreated ones was earlier than those received treatment E(28.7±4.7)weeks vs (33.2±4.9) weeks, P=0. 001]. Amnioreduction improved the umbilical cord blood flow. For severe TTTS(stage Ⅲ～Ⅳ) with the onset before 26 weeks, the survival rate after amnioreduction was significantly high- er than those untreated ones[4/5 vs 0/5, P=0. 048)]. Conclusions Aminioreduetion is effective in improving the cord blood flow, prolonging the pregnancies, and achieving a higher fetal survival rate.     

羊水减量术治疗双胎输血综合征的效果评价

Objective To find out the clinical outcomes of twin-twin transfusion syndrome (TTTS) after aminioreduction. Methods Twenty-nine pregnancies with TTTS delivered in Beijing Gynecological and Obstetric Hospital from Nov. 1, 2002 to Sept. 30, 2007 were recruited. The effect of gestational age at the onset, the degree of TTTS and amnioreduction therapy on the fetal outcomes were compared. Results All of the 8 cases with the onset of TTTS before 26 weeks without treat- ment were lost, but 4 out of the 6 with the onset after 26 weeks survived (P=0. 015). Among the 9 cases received amnioreduction, 4 out of the 5 with onset before 26 weeks survived, and significant difference was found compared to those untreated ones (P= 0. 007), but no difference was shown when compared with those developed after 26 weeks(4/4)(P= 1. 000). The average delivery weeks in the untreated ones was earlier than those received treatment E(28.7±4.7)weeks vs (33.2±4.9) weeks, P=0. 001]. Amnioreduction improved the umbilical cord blood flow. For severe TTTS(stage Ⅲ～Ⅳ) with the onset before 26 weeks, the survival rate after amnioreduction was significantly high- er than those untreated ones[4/5 vs 0/5, P=0. 048)]. Conclusions Aminioreduetion is effective in improving the cord blood flow, prolonging the pregnancies, and achieving a higher fetal survival rate.     

羊水减量术治疗双胎输血综合征的效果评价

目的 探讨羊水减量术治疗双胎输血综合征(TTTS)的临床效果.方法 选择2002年11月1日至2007年9月30日在北京妇产医院分娩的29例TTTS,比较其发病孕周、TTTS分期、羊水减量治疗对胎儿结局的影响.结果 未行羊水减量治疗的20例中,妊娠26周前发病的8例胎儿全部死亡,26周后发病的6例胎儿存活4例(至少1胎存活)(P=0.015),余6例为34周后发病.接受羊水减量治疗的9例中,26周前发病的5例胎儿存活4例,与同孕周未治疗组比较差异有统计学意义(P=0.007),与26周后发病的治疗组(4/4)比较无统计学意义(P=1.000).未治疗者平均分娩孕周早于治疗者[(28.7±4.7)周和(33.2±4.9)周,P=0.001].羊水减量可有效改善胎儿脐血流.严重TTTS患者(Ⅲ～Ⅳ期)羊水减量术可使26周前发病者的胎儿存活率明显高于未治疗组(4/5和0/5,P=0.048).结论 羊水减量术可有效改善TTTS胎儿脐血流,延长孕周,提高胎儿存活率.     

羊水减量术治疗双胎输血综合征的效果评价

Objective To find out the clinical outcomes of twin-twin transfusion syndrome (TTTS) after aminioreduction. Methods Twenty-nine pregnancies with TTTS delivered in Beijing Gynecological and Obstetric Hospital from Nov. 1, 2002 to Sept. 30, 2007 were recruited. The effect of gestational age at the onset, the degree of TTTS and amnioreduction therapy on the fetal outcomes were compared. Results All of the 8 cases with the onset of TTTS before 26 weeks without treat- ment were lost, but 4 out of the 6 with the onset after 26 weeks survived (P=0. 015). Among the 9 cases received amnioreduction, 4 out of the 5 with onset before 26 weeks survived, and significant difference was found compared to those untreated ones (P= 0. 007), but no difference was shown when compared with those developed after 26 weeks(4/4)(P= 1. 000). The average delivery weeks in the untreated ones was earlier than those received treatment E(28.7±4.7)weeks vs (33.2±4.9) weeks, P=0. 001]. Amnioreduction improved the umbilical cord blood flow. For severe TTTS(stage Ⅲ～Ⅳ) with the onset before 26 weeks, the survival rate after amnioreduction was significantly high- er than those untreated ones[4/5 vs 0/5, P=0. 048)]. Conclusions Aminioreduetion is effective in improving the cord blood flow, prolonging the pregnancies, and achieving a higher fetal survival rate.     

羊水减量术治疗双胎输血综合征的效果评价

Objective To find out the clinical outcomes of twin-twin transfusion syndrome (TTTS) after aminioreduction. Methods Twenty-nine pregnancies with TTTS delivered in Beijing Gynecological and Obstetric Hospital from Nov. 1, 2002 to Sept. 30, 2007 were recruited. The effect of gestational age at the onset, the degree of TTTS and amnioreduction therapy on the fetal outcomes were compared. Results All of the 8 cases with the onset of TTTS before 26 weeks without treat- ment were lost, but 4 out of the 6 with the onset after 26 weeks survived (P=0. 015). Among the 9 cases received amnioreduction, 4 out of the 5 with onset before 26 weeks survived, and significant difference was found compared to those untreated ones (P= 0. 007), but no difference was shown when compared with those developed after 26 weeks(4/4)(P= 1. 000). The average delivery weeks in the untreated ones was earlier than those received treatment E(28.7±4.7)weeks vs (33.2±4.9) weeks, P=0. 001]. Amnioreduction improved the umbilical cord blood flow. For severe TTTS(stage Ⅲ～Ⅳ) with the onset before 26 weeks, the survival rate after amnioreduction was significantly high- er than those untreated ones[4/5 vs 0/5, P=0. 048)]. Conclusions Aminioreduetion is effective in improving the cord blood flow, prolonging the pregnancies, and achieving a higher fetal survival rate.