Background Monochorionic multiple pregnancies （MMPs） are associated with higher rates of perinatal morbidity and mortality caused by interfetal vascular anastomoses in the monochorionic placenta, which can lead to f...Background Monochorionic multiple pregnancies （MMPs） are associated with higher rates of perinatal morbidity and mortality caused by interfetal vascular anastomoses in the monochorionic placenta, which can lead to fetal health interactions. In some circumstances, selective feticide of the affected fetus is necessary to save the healthy co-twin. We evaluated the effects and safety of our initial experiences using bipolar cord coagulation for the management of complicated MMPs. Methods Using ultrasound-guided bipolar cord coagulation, we performed selective feticide on 14 complicated MMPs （5 with twin-twin transfusion syndrome, 4 with acardia, 3 with discordant structural anomalies, and 2 with severe selective intrauterine growth restriction）. One patient with monochorionic triplets received the procedure twice to terminate 2 affected fetuses for different JndJcatJons. Data regarding the operations, complications and neonatal outcomes were analyzed. Results Cord occlusions were successfully performed in 13/14 （93%） cases. The failure happened in an acardiac fetus and the pregnancy was terminated by induction. The included cases delivered at a mean gestational age of 35.4 weeks with a perinatal survival rate of 11/13 （85%）. Three operation-related complications occurred （21%）, including membrane rupture of the terminated sac （1 case）, preterm labor at 28 weeks gestation （1 case）, and chorioamniotic membrane separation （1 case）. Amnioinfusion was indicated in 11 procedures to expand the target sacs for entering the trocar and obtaining sufficient working space. However, in all 4 cases of acardia, the acardiac sacs showed extreme oligohydramnios and could not be well expanded by infusion; thus, the trocar had to be inserted from the sac of the preserved co-twin. Conclusions The application of bipolar cord coagulation in complicated MMPs is safe and improves the prognosis. Amnioinfusion is useful in helping to expand the target sac when the working space is limited.展开更多
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
文摘Background Monochorionic multiple pregnancies （MMPs） are associated with higher rates of perinatal morbidity and mortality caused by interfetal vascular anastomoses in the monochorionic placenta, which can lead to fetal health interactions. In some circumstances, selective feticide of the affected fetus is necessary to save the healthy co-twin. We evaluated the effects and safety of our initial experiences using bipolar cord coagulation for the management of complicated MMPs. Methods Using ultrasound-guided bipolar cord coagulation, we performed selective feticide on 14 complicated MMPs （5 with twin-twin transfusion syndrome, 4 with acardia, 3 with discordant structural anomalies, and 2 with severe selective intrauterine growth restriction）. One patient with monochorionic triplets received the procedure twice to terminate 2 affected fetuses for different JndJcatJons. Data regarding the operations, complications and neonatal outcomes were analyzed. Results Cord occlusions were successfully performed in 13/14 （93%） cases. The failure happened in an acardiac fetus and the pregnancy was terminated by induction. The included cases delivered at a mean gestational age of 35.4 weeks with a perinatal survival rate of 11/13 （85%）. Three operation-related complications occurred （21%）, including membrane rupture of the terminated sac （1 case）, preterm labor at 28 weeks gestation （1 case）, and chorioamniotic membrane separation （1 case）. Amnioinfusion was indicated in 11 procedures to expand the target sacs for entering the trocar and obtaining sufficient working space. However, in all 4 cases of acardia, the acardiac sacs showed extreme oligohydramnios and could not be well expanded by infusion; thus, the trocar had to be inserted from the sac of the preserved co-twin. Conclusions The application of bipolar cord coagulation in complicated MMPs is safe and improves the prognosis. Amnioinfusion is useful in helping to expand the target sac when the working space is limited.
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.
文摘目的探讨在妊娠早期行多胎妊娠减胎术(multifetal pregnancy reduction,MFPR)是否影响体外受精-胚胎移植(In vitro fertilization and embryo transfer,IVF-ET)妊娠结局。方法选自2008年1月~2018年12月在焦作市妇幼保健院生殖中心接受IVF-ET助孕的患者,对移植后出现多胎妊娠并于妊娠6~8w在我中心行经阴道B超引导胚胎抽吸术的222例患者的病例资料进行回顾性分析,根据减胎术后保留单、双胎将患者分为减为单胎组和减为双胎组,并选择同期在我院生殖中心行IVF-ET助孕后单胎、双胎妊娠的222例患者为对照组(未减胎组)。首先比较组间患者的年龄,不孕年限、体重指数(body mass index,BMI=体重/身高2(kg/m^(2))、移植日子宫内膜厚度、早期流产率、晚期流产率、分娩孕周、早产率、新生儿出生体质量、小于胎龄儿(Small for gestation,SGA出生体重低于同胎龄应有体重第10百分位数以下)、妊娠并发症率(包括妊娠期糖尿病、妊娠期高血压病)及新生儿出生缺陷率等。其次比较伴单绒毛膜双胎三胎妊娠减单绒毛膜双胎之一(A组)与异卵三胎妊娠保留双胎(B组)组间妊娠结局。结果①单胎组:减为单胎组与单胎组间一般助孕情况、妊娠结局及并发症率组间比较均无差异(P>0.05)。②双胎组:减为双胎组SGA率较非减胎组高,且差异具有统计学意义(P<0.05)。③A组自发性减胎率(spontaneous pregnancy reduction,SPR)高于B组,且差异具有统计学意义(P<0.05)。结论①多胎妊娠在妊娠早期减为单胎可以获得与单胎妊娠相近似的妊娠结局,并降低多胎妊娠带来的严重母婴并发症发生率。②多胎妊娠在妊娠早期减为双胎后有增加子代SGA风险。③较伴单绒毛膜双胎三胎妊娠减单绒毛膜双胎之一虽然增加SPR风险,但剩余单绒毛膜单胎均可获得健康子代,因此在某些特定情况下伴单绒毛膜双胎三胎妊娠减单绒毛膜双胎之一是可行的。
