[Role of amniodrainage and color Doppler in the management of the twin-to-twin fetal blood transfusion syndrome].
The purpose of this study was to evaluate our experience with twin-to-twin transfusion syndrome (TTTS) and to determine the effectiveness in treating TTTS with amniodrainage and use of color Doppler. 31 out of 45 pregnant women were diagnosed with TTTS. The average gestational age at time of diagnosis was 20 weeks (range 16w to 33 w). During the course of treatment we have performed 29 standard and 20 aggressive amnioreduction procedures and 3 procedures of septostomy. Color Doppler studies of fetal-maternal vessels (a. and v. umbilical, middle cerebral artery, ductus venosus, a. renalis, a. uterine) were done in all cases before and after procedures. The average number of amniocentesis performed per patient was 3 (range 1 to 7). The average total volume of amniotic fluid removed per patient over the course of the pregnancy was 3.2 L (range 500 to 8000 ml). In 22 (70.9%) cases pregnancy was prolonged to 4-15 weeks. After amnioreduction the indexes of umbilical and uterine blood flow were improved and were depended on the level of polygydramnion revealing decrease of resistance. The risk of perinatal death was associated with an absent or reversed end-diastolic blood flow in the donor umbilical artery and with a pulsatile umbilical vein or absent or reversed end-diastolic flow in the ductus venosus of the recipient. The renal artery PI in recipient was lower than in donor (p<0.01). In cases with septostomy we found an elevation of the donor's urine bladder, probably as a consequence of a diminished level of hypovolemia and this resulted in an improvement of the renal function. 67.7% of the treated fetuses survived. Neonatal morbidity was 23.8% among the survivors. Average gestational age of delivery was 32 weeks (range 20-37 w). These findings may play a significant role in consulting parents in presence of TTTS and in selecting the appropriate treatment strategy in regards to the perinatal outcome.
Davarashvili
D
D
Ambulatory-Therapy Union N2, Department of Obstetrics and Gynaecology, Tbilisi, Georgia.
Nikolaishvili
T
T
D000650:Amnion / Q000601:surgery*; D000653:Amniotic Fluid / Q000502:physiology*; D003937:Diagnosis, Differential; D004322:Drainage / Q000379:methods; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis / Q000503:physiopathology; D005330:Fetofetal Transfusion / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications; D011263:Pregnancy Trimester, Third; D011272:Pregnancy, Multiple; D011446:Prospective Studies; D018615:Ultrasonography, Doppler, Color / Q000379:methods*; D014599:Uterus / Q000098:blood supply / Q000000981:diagnostic imaging