双胎贫血-红细胞增多序列征的产前超声诊断及围产结局分析

Prenatal ultrasound diagnosis and perinatal outcomes analysis of twin anemia-polycythemia sequence

目的:总结本中心双胎贫血-红细胞增多序列征(TAPS)的产前超声特征和围产结局,提高超声医生对本病的认识。方法:整理2018年1月—2021年12月郑州大学第三附属医院超声科、产科及新生儿科诊断为TAPS的病例,分析产前超声资料、产前处理及分娩后新生儿的临床资料。结果:产前及产后共诊断25例TAPS,产前超声诊断21例TAPS,均为单绒毛膜双胎,Ⅰ期11例,Ⅱ期3例,Ⅲ期0例,Ⅳ期7例,Ⅴ期0例。产前超声漏诊4例。共有的超声征象为:①一胎儿MCA-PSV>1.5 Mom,另一胎儿MCA-PSV<1.0 Mom;②“黑白”胎盘。其他超声特征:受血儿“星空肝”;胎盘厚度差异;供血儿水肿;胎儿体质量差>25%;羊水不均衡。宫内治疗12例,存在A-A分流4例,V-V分流7例,A-V分流12例。83.3%(5/6)接受宫内治疗的新生儿Hb差异<80 g/L,未进行宫内治疗者,产后均符合TAPS诊断。结论:产前超声MCA-PSV差异和胎盘分界明显对TAPS有较高的预测价值。胎儿镜下胎盘血管吻合支激光凝固术是改善预后的有效治疗手段。

Objective: To summarize the prenatal ultrasound characteristics and perinatal outcomes of twin anemia-polycythemia sequence(TAPS), and to improve the understanding of doctors in department of ultrasound. Methods: The cases of TAPS diagnosed by the Department of Ultrasound, Obstetrics and Neonatology of the Third Affiliated Hospital of Zhengzhou U-niversity from January 2018 to December 2021 were sorted out, and the prenatal ultrasound data, prenatal surgery data and clinical data of newborns after delivery were analyzed. Results: Twenty-five cases of TAPS were diagnosed prenatally and postnatally, and 21 cases were diagnosed by prenatal ultrasound. All of them were monochorionic twins. There were 11 cases in stage Ⅰ, 3 cases in stage Ⅱ, 0 case in stage Ⅲ, 7 cases in stage Ⅳ and 0 case in stage Ⅴ. Four cases were missed diagnosis by prenatal ultrasound. The common ultrasonic signs were:(1)MCA-PSV of one fetus was more than 1.5 Mom, and MCA-PSV of the other fetus was less than 1.0 Mom.(2) “Black and white” placenta. Other ultrasonic signs included: “starry liver” in recipient fetuses;placental thickness difference;edema in donor fetuses;the discordance in estimated fetal weight more than 25%;amniotic fluid imbalance. Intrauterine surgery were performed in 12 cases, A-A shunts were in 4 cases, V-V shunts were in 7 cases and A-V shunts were in 12 cases. 83.3%(5/6) of newborns receiving intrauterine treatment had a dif-ference of Hb<80 g/L. Those who did not receive intrauterine treatment met the diagnosis of neonatal TAPS. Conclusion: The significant discordance of twin’s MCA-PSV and clear boundary of placenta have high predictive value for TAPS by prenatal ultrasound. Laser coagulation of anastomotic branches of placental vessels under fetal microscope is an effective treatment to improve the prognosis.