本文章2013年6月发表于《Ultrasound Obstet and Gynecol》杂志上,文章研究了TTTSⅣ期胎儿镜下激光凝固胎盘吻合血管术后受血胎的心功能的情况。作者回顾分析了1998年2月至2011年10月间在加拿大多伦多西奈山医院行胎儿镜下激光凝固胎盘...本文章2013年6月发表于《Ultrasound Obstet and Gynecol》杂志上,文章研究了TTTSⅣ期胎儿镜下激光凝固胎盘吻合血管术后受血胎的心功能的情况。作者回顾分析了1998年2月至2011年10月间在加拿大多伦多西奈山医院行胎儿镜下激光凝固胎盘吻合血管术的22例TTTSⅣ期病例的产前超声、术前及术后胎儿超声心动图及新生儿结局。主要评估指标是心肌做功指数(myocardial performance index,MPI)。展开更多
Objective: This study was undertaken to detect missed anastomoses on the chorionic surface as well as hidden connections in the depth of the cotyledons in placentas after laser coagulation for twin-to-twin transfusion...Objective: This study was undertaken to detect missed anastomoses on the chorionic surface as well as hidden connections in the depth of the cotyledons in placentas after laser coagulation for twin-to-twin transfusion syndrome (TTTS) and to correlate these findings to clinical outcome. Study design: All cord vessels were injected with dyed barium sulphate. A digital photograph of the chorionic surface angioarchitecture and single-shot digital X- ray (Rx) angiograms were made. The presence and diameter of any missed anastomoses on the chorionic surface and of any hidden angiographic connections were determined. Results: Fifty placentas were analyzed,7 of double intrauterine fetal death (IUFD) and 43 of double survivors. In 9 of 43 (21% ) cases with double survival and in all 7 cases of double IUFD, missed anastomoses were identified that should have been ablated by laser coagulation (P < .001). There appeared to be a correlation between the type and diameter of missed anastomoses on the chorionic surface and the clinical outcome. Placentas with missed large arteriovenous/venoarterial anastomoses (AV/VA) (N = 8) were from cases with recurrent TTTS or double IUFD (unless compensated by a large arterioarterial anastomosis [AA]). Next, missed small AV/VA (N = 4) without AA resulted in isolated (ie, without TTTS) discordant hemoglobin levels requiring intrauterine transfusion. Finally, when there were no missed anastomoses (N = 34), TTTS had resolved in all cases and outcome was good, although 1 case had discordant hemoglobin values treated with a single intrauterine transfusion and 4 others had discordant hemoglobin at birth. On Rx angiography, potential hidden connections were present, all but 1 case. Conclusion: Coagulation of all anastomoses visible on the chorionic surface seems adequate to treat TTTS. However, hidden connections in the depth of the cotyledon could not be excluded and may be involved in lesser degrees of intertwin transfusion.展开更多
The purpose of this study was to evaluate the perioperative complications in fetoscopy-guided laser therapy in feto-fetal transfusion syndrome. Study design: Details of feto-fetal transfusion syndrome cases who were d...The purpose of this study was to evaluate the perioperative complications in fetoscopy-guided laser therapy in feto-fetal transfusion syndrome. Study design: Details of feto-fetal transfusion syndrome cases who were delivered between 1999 and 2004 in a single center were reviewed retrospectively. Results: One hundred seventy-five procedures were performed percutaneously with the use of local anesthesia. Survival at 6 months of at least 1, 1, and 2 babies was 73% , 38% , and 35% , respectively. Placental abruption and miscarriage was diagnosed in 3 and 12 cases, respectively. Premature rupture of membranes occurred in 49 cases (28% ) and including 12, 29, and 46 cases that occurred before 24, 28, and 34 weeks of gestation, respectively. The entry of the trocar was transpla- cental in 48 cases (27% ), but it was not associated with miscarriage (P = .26), premature rupture of membranes (P = .58), or placental abruption (P = .37). Conclusion: Fetoscopic laser treatment of feto-fetal transfusion syndrome can be performed percutaneously with local anesthesia without significant maternal morbidity. Transplacental entry was not associated with premature rupture of membranes or miscarriage.展开更多
文摘Objective: This study was undertaken to detect missed anastomoses on the chorionic surface as well as hidden connections in the depth of the cotyledons in placentas after laser coagulation for twin-to-twin transfusion syndrome (TTTS) and to correlate these findings to clinical outcome. Study design: All cord vessels were injected with dyed barium sulphate. A digital photograph of the chorionic surface angioarchitecture and single-shot digital X- ray (Rx) angiograms were made. The presence and diameter of any missed anastomoses on the chorionic surface and of any hidden angiographic connections were determined. Results: Fifty placentas were analyzed,7 of double intrauterine fetal death (IUFD) and 43 of double survivors. In 9 of 43 (21% ) cases with double survival and in all 7 cases of double IUFD, missed anastomoses were identified that should have been ablated by laser coagulation (P < .001). There appeared to be a correlation between the type and diameter of missed anastomoses on the chorionic surface and the clinical outcome. Placentas with missed large arteriovenous/venoarterial anastomoses (AV/VA) (N = 8) were from cases with recurrent TTTS or double IUFD (unless compensated by a large arterioarterial anastomosis [AA]). Next, missed small AV/VA (N = 4) without AA resulted in isolated (ie, without TTTS) discordant hemoglobin levels requiring intrauterine transfusion. Finally, when there were no missed anastomoses (N = 34), TTTS had resolved in all cases and outcome was good, although 1 case had discordant hemoglobin values treated with a single intrauterine transfusion and 4 others had discordant hemoglobin at birth. On Rx angiography, potential hidden connections were present, all but 1 case. Conclusion: Coagulation of all anastomoses visible on the chorionic surface seems adequate to treat TTTS. However, hidden connections in the depth of the cotyledon could not be excluded and may be involved in lesser degrees of intertwin transfusion.
文摘The purpose of this study was to evaluate the perioperative complications in fetoscopy-guided laser therapy in feto-fetal transfusion syndrome. Study design: Details of feto-fetal transfusion syndrome cases who were delivered between 1999 and 2004 in a single center were reviewed retrospectively. Results: One hundred seventy-five procedures were performed percutaneously with the use of local anesthesia. Survival at 6 months of at least 1, 1, and 2 babies was 73% , 38% , and 35% , respectively. Placental abruption and miscarriage was diagnosed in 3 and 12 cases, respectively. Premature rupture of membranes occurred in 49 cases (28% ) and including 12, 29, and 46 cases that occurred before 24, 28, and 34 weeks of gestation, respectively. The entry of the trocar was transpla- cental in 48 cases (27% ), but it was not associated with miscarriage (P = .26), premature rupture of membranes (P = .58), or placental abruption (P = .37). Conclusion: Fetoscopic laser treatment of feto-fetal transfusion syndrome can be performed percutaneously with local anesthesia without significant maternal morbidity. Transplacental entry was not associated with premature rupture of membranes or miscarriage.
