Ginekologia polska · 2000
[Serial amniocentesis in TTTS].
Клиническое исследованиеАннотация на английскомСтатьяНазвание и аннотация: Перевод в очереди
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Szaflik K, Borowski D, Wilczyński J, Wyrwas D, Kozarzewski M, Hincz P, Ciesielski A
Аннотация
AIM OF THE STUDY: The aim of our study was to estimate the efficacy of serial amniocentesis in cases of acute polyhydramnion in TTTS. We analyzed the time and the route of delivery, as well as the status of newborns.
MATERIAL AND METHODS: The study group consisted of 13 twins with confirmed hydramnios. In each case thorough examination allowed to make the diagnosis of TTTS. After the examination patients were prepared for amnioreduction. During the procedure the excess of amniotic fluid was removed through the punction needle.
RESULTS: The therapy of TTTS was based mainly on serial amniocentesis. In 2 cases, due to an extremely high amniotic volume, the therapy was started with placing the catheter to provide continuous amniotic drainage. The volume of AF removed during the single amniocentesis varied between 700-3000 ml and depended on AFI and the gestational age. In one case maternal treatment with indomethacin was introduced beside amniocentesis and in 3 pregnancies the Digoxin therapy was implemented together with amniocentesis. In all cases the deliveries were preterm. The mean donor weight was 730 +/- 290 g and the mean recipient weight was 1145 +/- 435 g (the difference was approximately 37%). In 7 cases we observed an intrauterine demise of one fetus. The 5th min Apgar score was 1 pt (median). When the analysis was performed after exclusion of stillborns, the median Apgar score for donors and recipients was 4 and 2 pt respectively.
CONCLUSIONS: 1. Acute TTTS is a rare pathology occurring in monochorionic twin gestations. 2. The concomitant pathologies include: acute hydramnios, preterm labor and delivery, intrauterine growth restriction, cardiac failure. 3. Serial amniocentesis are effective in significant prolongation of gestation (the mean interval between diagnosis and delivery 24 days). 4. The improvement of perinatal outcomes in twin gestations complicated by TTTS can be achieved by the combination of serial amniocentesis and the laser ablation of anastomoses.
MATERIAL AND METHODS: The study group consisted of 13 twins with confirmed hydramnios. In each case thorough examination allowed to make the diagnosis of TTTS. After the examination patients were prepared for amnioreduction. During the procedure the excess of amniotic fluid was removed through the punction needle.
RESULTS: The therapy of TTTS was based mainly on serial amniocentesis. In 2 cases, due to an extremely high amniotic volume, the therapy was started with placing the catheter to provide continuous amniotic drainage. The volume of AF removed during the single amniocentesis varied between 700-3000 ml and depended on AFI and the gestational age. In one case maternal treatment with indomethacin was introduced beside amniocentesis and in 3 pregnancies the Digoxin therapy was implemented together with amniocentesis. In all cases the deliveries were preterm. The mean donor weight was 730 +/- 290 g and the mean recipient weight was 1145 +/- 435 g (the difference was approximately 37%). In 7 cases we observed an intrauterine demise of one fetus. The 5th min Apgar score was 1 pt (median). When the analysis was performed after exclusion of stillborns, the median Apgar score for donors and recipients was 4 and 2 pt respectively.
CONCLUSIONS: 1. Acute TTTS is a rare pathology occurring in monochorionic twin gestations. 2. The concomitant pathologies include: acute hydramnios, preterm labor and delivery, intrauterine growth restriction, cardiac failure. 3. Serial amniocentesis are effective in significant prolongation of gestation (the mean interval between diagnosis and delivery 24 days). 4. The improvement of perinatal outcomes in twin gestations complicated by TTTS can be achieved by the combination of serial amniocentesis and the laser ablation of anastomoses.