胎儿生长限制IIa型和IIb型的分类适用于双胞胎输血综合征
Michelle T Nguyen1, Jinnen Masri1, Martha A Monson2
1Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA (Dr Nguyen, Ms Masri, and Dr Chmait).
American journal of obstetrics & gynecology MFM
|July 8, 2023
概括
在双胞胎输血综合征的单胞胎双胞胎中,选择性胎儿生长限制II型的分类至关重要. 与IIa型相比,IIb型分类表明激光手术后捐赠双胞胎存活率较差.
科学领域:
- 周围生理学 周围生理学
- 孕产妇和胎儿医学 孕产妇和胎儿医学
- 新生儿科学 新生儿科学
背景情况:
- 选择性胎儿生长限制 (sFGR) II型和双胞胎输血综合征 (TTTS) 经常在临床上重叠.
- 将sFGR II型分为IIa和IIb的分类是基于多普勒发现,影响激光手术后新生儿的结果.
研究的目的:
- 为了比较 TTTS 中的捐赠双胞胎新生儿存活率与同时发生的 sFGR 类型 IIa 与激光手术后的 IIb 类型.
主要方法:
- 用III阶段TTTS和用激光手术治疗的II型捐赠体sFGR进行单胎怀孕的回顾性研究 (2006-2021年).
- sFGR II型,以估计的胎儿体重<10百分点和动脉多普勒异常来定义.
- 分类为IIa (正常的MCA/DV多普勒) 和IIb (异常的MCA/DV多普勒).
- 后勤回归分析以比较30天的捐赠双胞胎存活率,调整共变量.
主要成果:
- 包括177名患者:146名 (82%) 患有sFGR IIa和31名 (18%) 患有sFGR IIb.
- 与sFGR IIa (71.2%) (P=.003) 相比,sFGR IIb (41.9%) 的捐赠双胞胎存活率明显较低.
- 患有sFGR IIb的患者的捐赠者存活率降低了66% (调整后OR,0.34;P=.0127).
结论:
- 在TTTS中,sFGR II型的IIa和IIb分类在TTTS中具有临床意义.
- 在TTTS的背景下,sFGR IIb表明在激光手术后捐赠双胞胎生存的预后较差.
- 对于具有sFGR IIb的TTTS的激光手术应提供共享决策,承认双重生存的潜力.
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