The complications of monochorionic （MC） multiple pregnancies include twin-reversed arterial perfusion（TRAP） and twin-to-twin transfusion syndrome （TTTS）. Currently, the most effective treatment for stages Ⅱ,Ⅲ,...The complications of monochorionic （MC） multiple pregnancies include twin-reversed arterial perfusion（TRAP） and twin-to-twin transfusion syndrome （TTTS）. Currently, the most effective treatment for stages Ⅱ,Ⅲ, and Ⅳ TTTS is generally considered to be fetoscopic laser occlusion of chorioangiopagous vessels （FLOC）.3 MC twins who are severely discordant for growth or demonstrate anomalies may undergo selective reduction by means of a variety of different techniques.4 Radiofrequency ablation （RFA） of an acardiac twin has also proved to be an effective method of improving survival of the pump twin in the TRAP. Therefore, care for these complex pregnancies is ideally a coordinated multidisciplinary effort between perinatology, pediatric/fetal surgery, pediatric neurology, radiology/ ultrasound, genetics, social services, neonatology, and labor and delivery.展开更多
目的探讨超声多普勒在双胎输血综合征(TTTS)胎儿射频消融减胎术(RFA)后治疗效果评估中的应用价值。方法回顾性纳入2020年8月至2022年2月在重庆医科大学附属妇女儿童医院进行宫内RFA治疗的单绒毛膜双胎病例25例。根据保留胎为受血胎儿或...目的探讨超声多普勒在双胎输血综合征(TTTS)胎儿射频消融减胎术(RFA)后治疗效果评估中的应用价值。方法回顾性纳入2020年8月至2022年2月在重庆医科大学附属妇女儿童医院进行宫内RFA治疗的单绒毛膜双胎病例25例。根据保留胎为受血胎儿或供血胎儿,分为受血胎组(13例)和供血胎组(12例)。术前及术后1、2、7 d对保留胎儿实行序贯超声多普勒评估,评估血管包括脐动脉、大脑中动脉(MCA)、静脉导管、脐静脉。采用单因素重复测量资料方差分析比较每组胎儿术前与术后1、2、7 d脐动脉、MCA各参数的差异,进一步两两比较采用Bonferroni法;采用Fisher精确概率法比较不同时间点静脉导管a波异常比例的差异和组间保留胎儿存活率的差异;同时对所有胎儿临床结局进行随访。结果所有TTTS病例中QuinteroⅣ期5例,Ⅲ期12例,Ⅱ期6例,Ⅰ期2例,其中合并选择性胎儿生长受限7例,双胎贫血-多血序列征3例,双胎之一结构畸形1例。超声多普勒评估:(1)脐动脉:2组胎儿脐动脉收缩期峰值流速/舒张末期流速(S/D)、脐动脉搏动指数(PI)术前与术后不同时间点差异均具有统计学意义(P均<0.05),其中与术后1 d比较,受血胎组术前脐动脉S/D(4.49±1.35 vs 3.88±1.13)、脐动脉PI(1.45±0.30 vs 1.31±0.25),供血胎组脐动脉PI(1.58±0.38 vs 1.27±0.20)均明显增高,差异具有统计学意义(P=0.004、0.010、0.003);(2)MCA:2组胎儿MCA收缩期峰值流速、MCA-PI、脑-胎盘血流比率术前与术后不同时间点差异均具有统计学意义(P均<0.05);(3)静脉导管:受血胎组术前静脉导管a波异常比例为38.5%(5/13),供血胎组术前异常比例为8.3%(1/12),2组胎儿术前与术后不同时间点差异均无统计学意义(P均>0.05)。共20例保留胎儿存活,总存活率为80.0%(20/25),供血胎组与受血胎组存活率比较[75.0%(9/12)vs 84.6%(11/13)],差异无统计学意义(P>0.05)。结论TTTS胎儿多存在血流动力学异常,展开更多
Introduction: This study aimed to evaluate, discuss and illustrate the role of fetoscopy diagnostically and therapeutically. Material and Methods: This study was conducted in private center in under the supervision of...Introduction: This study aimed to evaluate, discuss and illustrate the role of fetoscopy diagnostically and therapeutically. Material and Methods: This study was conducted in private center in under the supervision of the professors of Azhar University, Egypt from Dec-2012 to Mar-2017. Women with confirmed fetal congenital malformations, and willing to do fetoscopy were recruited. Fetoscopy was attempted in all cases to treat the underlying fetal conditions. Follow up was made until delivery. Results: Twenty patients with 22 fetuses were included in this study with different congenital anomalies. Therapeutic drainage or coagulation was made in all cases. In cases of lower urinary tract obstruction, fetoscopy confirmed pre-suspected urethral atresia and changed the diagnosis from complete PUV to urethral atresia in some cases. The procedure succeeded in all cases. However, the on-going success rate was 17 (77.3%) of fetuses. The overall number of live birth was 11 fetuses (50%). Overall, 15 (75%) of the 20 patients experienced some complication withpreterm labor the most prevalent 15 (75%). Conclusion: Fetoscopy can diagnose and differentiate between posterior urethral valve (PUV) and atresia, and manage well-selected cases of twin to twin transfusion syndrome (TTTS), and have a reasonable survival rate in lower urinary tract obstruction (LUTO).展开更多
Aim: We attempted to illustrate our experience of fetoscopic therapy in a tertial institute, whereby to highlight the present Egyptian situation regarding this issue. We described fetoscopic therapy undergone at Al-Hu...Aim: We attempted to illustrate our experience of fetoscopic therapy in a tertial institute, whereby to highlight the present Egyptian situation regarding this issue. We described fetoscopic therapy undergone at Al-Hussein Hospital, Al-Azhar University, Cairo, Egypt, from Dec-2012 to Sep-2019. Presentation of cases: Sixteen women with 17 fetuses were included in the analysis of this study with a mean age of 25.31 ± 6.15 years;four with positive marriage to a near relevant, and eight were primigravida. The fetus of twelve women had lower urinary tract obstruction (LUTO), two fetal anemia, one hydrothorax, and one twin-to-twin transfusion syndrome (TTTS). The mean time for fetoscopy was gestational week 24.13 ± 3.77. We did therapeutic drainage to amniotic fluid in hydrothorax and LUTO, therapeutic septostomy to the TTTS case, and blood transfusion in cases of fetal anemia. During the operation, the procedure succeeded in 14 out of 16 women. Overall, nine of the 16 women experienced some complications;five with rupture of membranes, four with preterm labor, and three with intrauterine fetal death (IUFD). Conclusion: Fetoscopy can manage LUTO and well-selected cases of TTTS, hydrothorax, and fetal anemia. The procedure is promising. Fetoscopic therapy has just begun in Egypt, and this report may contribute to the future advance of fetoscopic therapy in Egypt.展开更多
文摘The complications of monochorionic （MC） multiple pregnancies include twin-reversed arterial perfusion（TRAP） and twin-to-twin transfusion syndrome （TTTS）. Currently, the most effective treatment for stages Ⅱ,Ⅲ, and Ⅳ TTTS is generally considered to be fetoscopic laser occlusion of chorioangiopagous vessels （FLOC）.3 MC twins who are severely discordant for growth or demonstrate anomalies may undergo selective reduction by means of a variety of different techniques.4 Radiofrequency ablation （RFA） of an acardiac twin has also proved to be an effective method of improving survival of the pump twin in the TRAP. Therefore, care for these complex pregnancies is ideally a coordinated multidisciplinary effort between perinatology, pediatric/fetal surgery, pediatric neurology, radiology/ ultrasound, genetics, social services, neonatology, and labor and delivery.
文摘目的探讨超声多普勒在双胎输血综合征(TTTS)胎儿射频消融减胎术(RFA)后治疗效果评估中的应用价值。方法回顾性纳入2020年8月至2022年2月在重庆医科大学附属妇女儿童医院进行宫内RFA治疗的单绒毛膜双胎病例25例。根据保留胎为受血胎儿或供血胎儿,分为受血胎组(13例)和供血胎组(12例)。术前及术后1、2、7 d对保留胎儿实行序贯超声多普勒评估,评估血管包括脐动脉、大脑中动脉(MCA)、静脉导管、脐静脉。采用单因素重复测量资料方差分析比较每组胎儿术前与术后1、2、7 d脐动脉、MCA各参数的差异,进一步两两比较采用Bonferroni法;采用Fisher精确概率法比较不同时间点静脉导管a波异常比例的差异和组间保留胎儿存活率的差异;同时对所有胎儿临床结局进行随访。结果所有TTTS病例中QuinteroⅣ期5例,Ⅲ期12例,Ⅱ期6例,Ⅰ期2例,其中合并选择性胎儿生长受限7例,双胎贫血-多血序列征3例,双胎之一结构畸形1例。超声多普勒评估:(1)脐动脉:2组胎儿脐动脉收缩期峰值流速/舒张末期流速(S/D)、脐动脉搏动指数(PI)术前与术后不同时间点差异均具有统计学意义(P均<0.05),其中与术后1 d比较,受血胎组术前脐动脉S/D(4.49±1.35 vs 3.88±1.13)、脐动脉PI(1.45±0.30 vs 1.31±0.25),供血胎组脐动脉PI(1.58±0.38 vs 1.27±0.20)均明显增高,差异具有统计学意义(P=0.004、0.010、0.003);(2)MCA:2组胎儿MCA收缩期峰值流速、MCA-PI、脑-胎盘血流比率术前与术后不同时间点差异均具有统计学意义(P均<0.05);(3)静脉导管:受血胎组术前静脉导管a波异常比例为38.5%(5/13),供血胎组术前异常比例为8.3%(1/12),2组胎儿术前与术后不同时间点差异均无统计学意义(P均>0.05)。共20例保留胎儿存活,总存活率为80.0%(20/25),供血胎组与受血胎组存活率比较[75.0%(9/12)vs 84.6%(11/13)],差异无统计学意义(P>0.05)。结论TTTS胎儿多存在血流动力学异常,
文摘Introduction: This study aimed to evaluate, discuss and illustrate the role of fetoscopy diagnostically and therapeutically. Material and Methods: This study was conducted in private center in under the supervision of the professors of Azhar University, Egypt from Dec-2012 to Mar-2017. Women with confirmed fetal congenital malformations, and willing to do fetoscopy were recruited. Fetoscopy was attempted in all cases to treat the underlying fetal conditions. Follow up was made until delivery. Results: Twenty patients with 22 fetuses were included in this study with different congenital anomalies. Therapeutic drainage or coagulation was made in all cases. In cases of lower urinary tract obstruction, fetoscopy confirmed pre-suspected urethral atresia and changed the diagnosis from complete PUV to urethral atresia in some cases. The procedure succeeded in all cases. However, the on-going success rate was 17 (77.3%) of fetuses. The overall number of live birth was 11 fetuses (50%). Overall, 15 (75%) of the 20 patients experienced some complication withpreterm labor the most prevalent 15 (75%). Conclusion: Fetoscopy can diagnose and differentiate between posterior urethral valve (PUV) and atresia, and manage well-selected cases of twin to twin transfusion syndrome (TTTS), and have a reasonable survival rate in lower urinary tract obstruction (LUTO).
文摘Aim: We attempted to illustrate our experience of fetoscopic therapy in a tertial institute, whereby to highlight the present Egyptian situation regarding this issue. We described fetoscopic therapy undergone at Al-Hussein Hospital, Al-Azhar University, Cairo, Egypt, from Dec-2012 to Sep-2019. Presentation of cases: Sixteen women with 17 fetuses were included in the analysis of this study with a mean age of 25.31 ± 6.15 years;four with positive marriage to a near relevant, and eight were primigravida. The fetus of twelve women had lower urinary tract obstruction (LUTO), two fetal anemia, one hydrothorax, and one twin-to-twin transfusion syndrome (TTTS). The mean time for fetoscopy was gestational week 24.13 ± 3.77. We did therapeutic drainage to amniotic fluid in hydrothorax and LUTO, therapeutic septostomy to the TTTS case, and blood transfusion in cases of fetal anemia. During the operation, the procedure succeeded in 14 out of 16 women. Overall, nine of the 16 women experienced some complications;five with rupture of membranes, four with preterm labor, and three with intrauterine fetal death (IUFD). Conclusion: Fetoscopy can manage LUTO and well-selected cases of TTTS, hydrothorax, and fetal anemia. The procedure is promising. Fetoscopic therapy has just begun in Egypt, and this report may contribute to the future advance of fetoscopic therapy in Egypt.
