Perinatal outcome following amniotic septostomy in chronic TTTS is independent of placental angioarchitecture

被引：5

作者：

Adedayo L Adegbite

Stuart B Ward

Rekha Bajoria

机构：

[1] University of Manchester, Academic Unit of Obstetrics, St Mary's Hospital, Manchester M13 0JH, Withworth Park

来源：

Journal of Perinatology | 2003年 / 23卷 / 6期

关键词：

D O I：

10.1038/sj.jp.7210969

中图分类号：

学科分类号：

摘要：

Objectives: To determine whether the vascular anatomy of monochorial placenta influences the success of amniotic septostomy for the treatment of chronic mid-trimester twin-twin transfusion syndrome, we report placental anastomoses and perinatal data of 13 pregnancies treated by amniotic septostomy in combination with amnioreduction (AR). The placental anastomoses were delineated postnatally by perfusion studies. Perinatal outcome was also evaluated in relation to umbilical artery Doppler waveform of the donor twin. Results: The median gestational age at septostomy was 21 weeks (rage 18 to 25.5 weeks). Amniotic septostomy in combimation with single AR procedure successfully resolved polyhydramnios in all cases. The median gestational age at delivery and the septostomy to delivery interval were 27 weeks (range 20 to 34 weeks) and 4 weeks (range 0.3 to 13.6 weeks), respectively. Of the 26 fetuses, 10 died in utero and four died within a week of life, with a combined survival rate of 46%. There was no relation between the clinical outcome and angioarchitecture of the placenta. However, pregnancy loss was higher in the donor twin with absent end-diastolic flow umbilical artery Doppler waveform than those with end-diastolic flow (85 vs 17%; p<0.001). Conclusion: This study suggests that although amniotic septostomy is a promising method for the correction of oligohydramnios and/or polyhydramnios, perinatal survival rate does not depend angioarchitecture of the placenta. Instead, umbilical artery Doppler waveform of the donor twin may be a better marker for survival rate.

引用

页码：498 / 503

页数：5

共 26 条

[11]

Quintero R.A., Comas C., Bornick P.W., Allen M.H., Kruger M., Selective versus non-selective laser photocoagulation of placental vessels in twin-to-twin transfusion syndrome, Ultrasound Obstet. Gynecol., 16, pp. 230-236, (2000)

[12]

Hubinont C., Bernard P., Pirot N., Biard J., Donnez J., Twin-to-twin transfusion syndrome: Treatment by amniodrainage and septostomy, Eur. J. Obstet. Gynecol. Reprod. Biol., 92, pp. 141-144, (1998)

[13]

Saade G.R., Belfort M.A., Berry D.L., Et al., Amniotic septostomy for the treatment of twin oligohydramnios-polyhydramnios sequence, Fetal Diagn. Ther., 13, pp. 86-93, (1998)

[14]

Pistorius L.R., Howarth G.R., Failure of amniotic septostomy in the management of 3 subsequent cases of severe previable twin-twin transfusion syndrome, Fetal Diagn. Ther., 14, pp. 337-340, (1999)

[15]

Bajoria R., Chorionic plate vascular anatomy determines the efficacy of amnioreduction therapy for twin-twin transfusion syndrome, Hum. Reprod., 13, pp. 1709-1713, (1998)

[16]

Dubinsky T., Lau M., Powell F., Et al., Predicting poor neonatal outcome: A comparative study of noninvasive antenatal testing methods, Am. J. Roentgenol., 168, pp. 827-831, (1997)

[17]

Fong K.W., Ohlsson A., Hannah M.E., Et al., Prediction of perinatal outcome in fetuses suspected to have intrauterine growth restriction: Doppler US study of fetal cerebral, renal, and umbilical arteries, Radiology, 213, pp. 681-689, (1999)

[18]

Joa E., Chari R., Mayes D., Demianczuk N., Okun N., Twin-to-twin transfusion syndrome: A review of 27 cases and the relationship between gestational age at diagnoses and serial amniocentesis on outcome, Obstet. Gynecol., 97, 4 SUPPL. 1, (2001)

[19]

Jackson M.R., Walsh A.J., Morrow R.J., Mullen J.B., Lye S.J., Ritchie J.W., Reduced placental villous tree elaboration in small-for-gestational-age pregnancies: Relationship with umbilical artery Doppler waveforms, Am. J. Obstet. Gynecol., 172, pp. 518-525, (1995)

[20]

Hitschold T.P., Doppler flow velocity waveforms of the umbilical arteries correlate with intravillous blood volume, Am. J. Obstet. Gynecol., 17, pp. 540-543, (1998)

← 1 2 3 →