Amniotic Fluid and Maternal Blood Characteristics in Severe Mid-Trimester Twin–Twin Transfusion Syndrome

医学 静脉导管 羊水 吻合 红细胞压积 双胎妊娠 产科 胎儿 脐动脉 胎龄 内科学 心脏病学
作者
Agnes Huber,W. Diehl,Liza Zikulnig,Karsten R. Held,Thomas Bregenzer,B.-Joachim Hackelöer,Kurt Hecher
出处
期刊:Fetal Diagnosis and Therapy [Karger Publishers]
被引量:7
标识
DOI:10.1159/000080163
摘要

To investigate the concentrations of metabolic variables in the amniotic fluid of the recipient twin and maternal blood and to correlate them with clinical features, which are characteristic for the course of pregnancies with twin-twin transfusion syndrome (TTS).In 109 pregnancies with severe mid-trimester TTS, we measured the concentrations of interleukin-6 (IL-6), alpha-fetoprotein (AFP), sodium, potassium, total protein, beta2-microglobulin and osmolality in the amniotic fluid of the recipient twin prior to laser coagulation of the vascular anastomoses and compared them to a control group of 92 singleton pregnancies. We measured the pulsatility index (PI) of ductus venosus flow velocity waveforms in the recipient twin and performed a retrospective chart analysis for complete maternal blood count before and after the procedure.All variables, except osmolality, IL-6 and AFP were significantly lower in the TTS group. There was a significant positive correlation between PI in the ductus venosus and the amniotic fluid AFP concentrations (r = 0.355; p < 0.001). There was a significant fall in complete maternal blood count after laser therapy (p < 0.001) and a significant correlation between the amount of amniotic fluid drained and the fall of maternal Hb (r = -0.261; p = 0.03) and hematocrit (r = -0.212; p = 0.01).Pathophysiologic changes in TTS do not only occur at the inter-twin level of placental vascular anastomoses but also at the materno-fetal level of fluid exchanges. AFP is correlated to the severity of congestive heart failure of the recipient twin.
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