双胎输血综合征的超声诊断分析

目的 评价超声在双胎输血综合征(TTTS)中的作用.方法 回顾分析12例被确诊TTTS胎儿的超声检查结果.结果 12例胎儿中,孕20周确诊3倒,孕24～35周确诊8例,孕36周后确诊1例.其中有5例双胎之一为水肿儿,3例伴胸腹水,双胎之一为贴附儿2例.含死胎的有3例.结论 超声作为一种无创性的检查,在TTTS的早期诊断具有很高的应用价值,能为临床提供科学的诊治依据.     

产前超声检查对双胎输血综合征的价值

目的评价产前超声检查对双胎输血综合征(TTTS)的价值。方法对2005年1月-2010年6月在我院孕早期就判断为单绒毛膜性的12例TTTS患者进行分期、宫内监测等。结果在超声协助下,胎儿存活率为44.4%。结论超声对TTTS可作出早期诊断,并指导临床进行有效的宫内治疗、适时终止妊娠,提高围产儿存活率。     

双胎输血综合征二例报道

一次妊娠同时有两个或两个以上胎儿妊娠称为多胎妊娠.因为多胎妊娠孕妇并发症围产期死亡率高,故临床作为异常妊娠对待.目前,所知多胎妊娠胎儿数目可达2～8个.以双胎妊娠最常见发生率11%左右.双胎妊娠分类:单卵双胎、双卵双胎两类.单卵双胎占20%～25%,双卵双胎占25%～80%.多胎妊娠孕产妇并发症多,围产儿死亡率明显升高.主要表现为早产,胎儿宫内发育迟缓、畸形,双胎输血综合征,脐带脱垂,胎头交锁,胎头碰撞等.本文介绍我院近10年来在多胎妊娠中,双羊膜囊,单绒毛膜、单卵双胎并发双胎输血综合征两例报道.     

14例新生儿双胎输血综合征临床超声影像观察研究

目的评价超声诊断双胎输血综合征应用价值;探讨新生儿双胎输血综合征临床表现及合并症等问题。方法应用二维及多普勒超声测定14例22～36周的双胎妊娠胎儿生长指标及脐动脉血流PI值、RI值、S/D值,观察活产和死胎所产双胎婴儿供血儿和受血儿的各项指标。结果超声诊断双胎输血综合征14例,诊断准确率92.8%（13/14）,双胎输血综合征具有一般双胎的临床共性,其中受血儿出现病理临床表现及合并症较供血儿多且严重。结论二维联合多普勒超声诊断双胎输血综合征有较高的准确率,是快捷诊断双胎输血综合征手段之一。双胎输血综合征对受血儿危害更大,临床一旦确诊为双胎输血综合征,应对受血儿进行严密监护,若出现临床表现并发红细胞增多症,应积极采取治疗措施以减少严重并发症及后遗症的发生。     

双胎输血综合征产前超声诊断及分析

目的探讨双胎输血综合征(TTTS)的产前超声诊断及TTTS发现时间与围产儿结局的关系,目前采用的治疗方法,改善围产儿结局和降低围产儿死亡风险。方法采用回顾性分析的方法对1323对双胎的羊膜囊数目以及羊膜隔带厚度、胎盘位置、数目、两胎性别及早期超声绒毛膜囊数目进行分析判断为MCT193例,超声测量胎儿双顶径、头围、腹围、股骨长、羊水指数、膀胱、胎盘厚度、回声,脐动脉血流动力学参数等超声表现进行分析符合TTTS诊断的患者有21对。结果 TTTS是MCT胎儿宫内死亡的主要原因,TTTS发生越早围产儿生存的风险性越高,期别进展与围产儿结局有一定关系,分期系统在监测病情进展方面更为有效。结论 TTTS是双胎妊娠的一个严重并发症,围产儿发病率及病死率极高,超声技术作为一种无创、安全、简便、快捷、可靠的检查是目前诊断TTTS的重要手段。     

12例双胎输血综合征供血患儿围生期的综合护理体会

目的：探讨施行围生期综合护理对双胎输血综合征供血患儿远期临床效果的影响。方法：按标准纳入对照组和实验组研究对象，进行围生期综合护理干预后，对比分析双胎输血综合征供血患儿出院时及1年后的贫血和脑损伤等并发症的护理效果。结果：进行围产期综合护理后，出院时和1年后双胎输血综合征供血患儿红细胞及血红蛋白含量与对照组无明显区别(P>0.05)；《Bayley婴幼儿发育量表》分析结果显示，随访双胎输血综合征供血患儿1年后，其智力量表用智力发展指数(mental development index，MDI)和运动发展指数(psychomotor development index，PDI)的各个水平分布的比率与常模相比，并无明显差异(P>0.05)。结论：输血综合征供血患儿围生期的综合护理可以有效改善其远期并发症的产生。     

双胎妊娠一胎死宫内原因及期待治疗的探讨

目的 探讨双胎妊娠中1胎死于宫内的死因及对母亲和存活胎儿的影响.方法 对1996年1月至2006年12月在我院分娩的双胎之一为宫内死胎的23例产妇临床资料进行回顾性分析.结果 双胎之一为宫内死胎的发生率占双胎的4.72%,其中单绒毛膜双胎14例,占60.87%,双绒毛膜双胎9例,占39.13%(519).胎儿死因脐带因素占34.79%,胎盘因素8例占34.8%,妊娠并发症5例占21.7%,双胎输血综合征2例占8.7%,胎儿畸形1例占4.35%(219),不明原因6例占26.09%.期待治疗最长达72天,双胎之一胎死官内后对母体的凝血功能影响不大.结论 脐带异常、胎盘异常是胎死宫内的重要原因;双胎之一胎死宫内对母体及存活儿有一定影响.但孕周小,胎儿尚不成熟,行期待治疗可延长孕龄至足月,以提高围生儿的存活率.     

双胎妊娠-胎宫内死亡20例临床分析

目的探讨双胎妊娠-胎宫内死亡的原因、临床处理及预后。方法回顾性分析1994年3月至2008年2月北京大学第三医院双胎妊娠-胎宫内死亡的病例共20例。结果双胎-胎宫内死亡的发生率为3．2％,其中双卵双胎17例,单卵双胎3例。28w前发现-胎宫内死亡者6例,平均期待治疗95．8天,平均分娩孕周为34．4w（32^＋4-39w）;28w后发现-胎宫内死亡者14例,平均期待治疗10．1天,平均分娩孕周为34．6w（29^＋4-39^＋2w）;仅2例新生儿发生轻度窒息。无一例孕妇发生凝血功能障碍。追踪新生儿6月至14年,1例新生儿因合并隐性脊柱裂及早产原因早期死亡,1例患儿3岁时发生运动障碍性脑瘫（分娩孕周为29^＋6w）,4例失访,其余均健康存活。结论双胎妊娠-胎宫内死亡后可采取期待治疗,严密监测存活胎儿宫内状况,尽量延长孕周,可提高存活胎儿的生存质量。     

Endothelin concentrations in monochorionic twins with severe twin-twin transfusion syndrome.

The objective of this study was to determine endothelin (ET-1) concentrations in monochorionic twin fetuses with and without twin-twin transfusion syndrome (TTTS). Fourteen monochorionic twin pregnancies complicated by TTTS and six without TTTS were studied. Matched maternal and fetal blood samples were obtained both in utero and at birth. Amniotic fluid samples were also collected from twin pairs. ET-1 concentrations were measured by radio-immunoassay. ET-1 concentrations in recipient fetuses were higher than in the donors both in utero(P < 0.001) and at birth (P < 0.01). Fetal concentrations of ET-1 in donors were similar to non-TTTS twins. Plasma ET-1 concentrations were significantly higher (P < 0.01) in recipient fetuses with severe hydrops than those with mild/no hydrops. Maternal concentrations of ET-1 were comparable in the two groups. Endothelin concentrations in recipient twins were 2(1/2) times higher than in their co-twins and this was related to the severity of hydrops.     

Congenital focal glomerular lesions in only one monozygotic twin related to a probable twin transfusion syndrome

A case of congenital focal glomerular lesions involving crescent formation in only one monozygotic twin is reported. The possible effect of chronic hypotension in the pathogenesis of the lesion is discussed, considering the fact that the affected twin was probably the donor in a feto-fetal transfusion syndrome.     

Maternal vascular endothelial growth factor receptor and interleukin levels in pregnant women with twin-twin transfusion syndrome

Twin-twin transfusion syndrome (TTTS) is an unusual and serious condition that occurs in twin pregnancies when identical twins share a placenta but develop discordant amniotic fluid volumes. TTTS is associated with an increased risk of fetal death and birth defects if untreated. This study investigated the soluble levels of biomarkers including growth factors and interleukins in pregnant women with and without TTTS during pregnancy. We quantified plasma levels of VEGF-R1, VEGF-R2, IL-1β, IL-6 and IL-8 in twin pregnant women with (n=53) and without TTTS (n=72) and in women with single pregnancy (n=30) by ELISA and analyzed the association of maternal circulating biomarker levels with TTTS. Our results showed that maternal VEGF-R1 levels were significantly higher in twins compared to single pregnancy (P<0.05) and were decreased in the second trimester compared to the first trimester (P = 0.065, 0.019 and 0.072 for twins with and without TTTS and single pregnancy, respectively). VEGF-R2 levels had a trend to be lower in twins compared to single pregnancy. In addition, soluble VEGF-R1 and VEGF-R2 levels were significantly decreased while IL-6 levels were increased after surgical treatment with laser in twin pregnant women with TTTS (P = 0.016, 0.041 and 0.04, respectively). These results suggest that IL-6, VEGF-R1 and VEGF-R2 are involved in vascular regulation and stabilization in twin pregnancies and may contribute to the pathogenesis of TTTS and thus play a prognostic role in the surgical treatment of TTTS.     

Early prediction of severe twin-to-twin transfusion syndrome

This extended series of 303 monochorionic twin pregnancies examined at 10-14 weeks gestation explores the possible association of increased fetal nuchal translucency thickness (NT) in the early prediction of severe twin-to-twin transfusion syndrome (TTS). Of 303 pregnancies, there were 16 in which at least one fetus was structurally or chromosomally abnormal and in the remaining 287 ongoing pregnancies there were 43 (15%) which developed severe TTS. The median fetal NT was 1.0 multiples of the median (MOM) and NT was >95th centile in 47 (8.2%) fetuses and in at least one fetus in 37 (12.9%) pregnancies. The prevalence of increased NT in the pregnancies that developed TTS [17.4% (n = 15) of fetuses and 28% (n = 12) of pregnancies] was significantly higher than in the non-TTS group [6.6% (n = 32) and 10.2% (n = 25) respectively; Z: = -3.4, P: < 0.001 and Z: = 3.2, P: < 0.001 respectively], likelihood ratio of increased fetal NT for prediction of TTS = 3.5 [95% confidence interval (CI) 1.9-6.2]. In 153 of the pregnancies, an ultrasound examination was also performed at 15-17 weeks gestation and intertwin membrane folding was seen in 49 (32%) cases; 21 of these (43%) subsequently developed TTS compared to two (1.9%) of the 104 pregnancies without membrane folding (Z: = 6.6, P: < 0.001), likelihood ratio of membrane folding for prediction of TTS = 4.2 (95% CI 3.0-6.0).     

Chorionic plate vascular anatomy determines the efficacy of amnioreduction therapy for twin-twin transfusion syndrome

The objective of the study was to determine whether vascular anatomy of monochorial placenta influences the therapeutic efficacy of serial amnioreduction in chronic mid-trimester twin-twin transfusion syndrome (TTTS). Twenty-six consecutive monochorial pregnancies complicated by TTTS and treated by serial amnioreduction were studied. The placental anastomoses were delineated postnatally by perfusion studies. Amniotic fluid index, amniotic fluid pressure, number of amnioreductions, interval between amnioreduction, and neonatal outcome were correlated with the presence or absence of superficial anastomotic channels and type of cord insertion. Placentae were divided into two groups according to the presence (n = 9) and absence (n = 14) of superficial anastomosis. Gestational age at diagnosis, delivery, percentage discordance in estimated birth weight were comparable in the two groups. The amniotic fluid index, liquor volume removed, and amniotic pressure at first amnioreduction were also comparable between groups. In the group without superficial arterio-arterial/veno-venous (AA/VV) anastomoses, amnioreduction was required more often (P < 0.05). Perinatal mortality in terms of intrauterine deaths (IUD) and neonatal death was more common in the group without AA/VV anastomotic channels (P < 0.05). There was no difference in incidence of velamentous/marginal cord insertion between the two groups. TTTS lacking superficial AA or VV anastomosis are more likely to require frequent amnioreduction and are associated with increased perinatal mortality and morbidity, whereas the presence of such shunts was associated with increased therapeutic efficacy of amnioreduction and a more favourable prognosis.      

Chimerism involving a RB1 pathogenic variant in monochorionic dizygotic twins with twin–twin transfusion syndrome

We report the first case of blood chimerism involving a pathogenic RB1 variant in naturally conceived monochorionic‐dizygotic twins (MC/DZ) with the twin–twin‐transfusion syndrome (TTTS), presumably caused by the exchange of stem‐cells. Twin A developed bilateral retinoblastoma at 7 months of age. Initial genetic testing identified a de novo RB1 pathogenic variant, with a 20% allelic ratio in both twins' blood. Subsequent genotyping of blood and skin confirmed dizygosity, with the affected twin harboring the RB1 pathogenic variant in skin and blood, and the unaffected twin carrying the variant only in blood.     

Study of the toxic and hemolytic properties of sera in the massive transfusion syndrome

The toxic and hemolytic properties of the sera of animals receiving massive transfusions of homologous blood were studied in experiments on 20 dogs and 432 mice. The toxicity of the recipients' sera was estimated in vivo in mice whose reticuloendothelial system had been blocked by Trypan Blue by calculating the mortality in per cent, and in vitro by the blood culture method. Hemolytic activity was studied by Dacie's principle with the use of erythrocytes labeled with radioactive chromium. The lost blood (45–50 ml/kg) was replaced in a volume 1.5 times greater than the volume of blood removed. The experiments showed that acute blood loss followed by massive transfusion of homologous blood caused the formation of toxic products in the recipient's serum. These toxic properties were found by two biological tests. The maximal toxigenic action was found 2 h and during the first day after blood replacement. On the 17th day no toxic effect of the sera could be found. During a parallel investigation of the hemolytic properties of the serum, a marked increase in its activity was discovered. The highest level of hemolytic activity was reached 24 h after blood replacement. After 3 days the hemolytic properties of the serum no longer differed from what they were initially.Presented by Academician of the Academy of Medical Sciences of the USSR N. A. Fedorov.Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 82, No. 7, pp. 792–794, July, 1976.