Prediction of Twin-to-Twin Transfusion Syndrome Using Characteristic Waveforms of Ductus Venosus in Recipient Twins
Prediction of Twin-to-Twin Transfusion Syndrome Using Characteristic Waveforms of Ductus Venosus in Recipient Twins
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DOI：
10.1017/thg.2020.73
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发表时间：
2020-10-01
影响因子：
0.9
通讯作者：
Morita, Mineto
中科院分区：
文献类型：
--
作者：
Takano, Mayumi;Nakata, Masahiko;Morita, Mineto
我们的目的是探讨静脉导管(DV)血流的时间间隔和速度-时间积分(VTIs)的改变是否可以预测单绒毛膜异位妊娠(MD)双胎妊娠中期演变的双胎输血综合征(TTTS)。对MD双胎妊娠的DV多普勒波形进行了回顾性分析。对TTTS受体双生子和MD双生子中较大的双生子进行了S波加速相(S1和Vti-1)、S波减速相(S2和Vti-2)和D波相(D和Vti-Diast)的时间间隔和VTI值的测量。每个参数被归一化为总的时间间隔和VTI。分析TTTS前孕期双胞胎的DV参数。TTTS前条件定义为TTTS病例达到标准前2周内的条件。TTTS组受孕双生子和TTTS前受孕双生子的S1、S2、D、VTI-1、VTI-2、VTI-Diast均显著短于MD双生子(P<0.05)。受试者-操作特征曲线分析显示，VTI-2具有较好的诊断效果，45.5%的VTI-2和GT；对妊娠前期双胎的诊断敏感性为87.0%，特异性为90.9%，阳性预测值为81.0%，阴性预测值为93.0%。合并TTTS的受者双胞胎在DV多普勒血流的时间间隔和VTI方面有特征性的改变，甚至在满足TTTS标准之前就已经存在。此外，VTI-2和GT；45.5%是孕中期TTTS的一个可能的预测参数。
We aimed to investigate whether the alterations of time intervals and velocity-time integrals (VTIs) of ductus venosus (DV) Doppler flow could predict evolving twin-to-twin transfusion syndrome (TTTS) in monochorionic diamniotic (MD) twin pregnancies in the second trimester. DV Doppler waveforms of MD twin pregnancies were retrospectively analyzed. Time intervals and VTIs of the accelerating phase of S-wave (S1 and VTI-1), decelerating phase of S-wave (S2 and VTI-2) and phase of D-wave (D and VTI-diast) were measured in the recipient twins of TTTS and the larger twins of uncomplicated MD twins. Each parameter was normalized to total time intervals and VTIs. DV parameters of prerecipient twins in pre-TTTS conditions were analyzed. The pre-TTTS condition was defined as the condition within 2 weeks before when TTTS cases fulfilled the criteria. Both recipient twins in TTTS cases and prerecipient twins in pre-TTTS condition showed significantly shorter S1, longer S2, shorter D, smaller VTI-1, larger VTI-2 and smaller VTI-diast than did the larger twins in uncomplicated MD twins (p < .05). Receiver-operating characteristic curve analysis showed that VTI-2 had better performance, and VTI-2 >45.5% had 87.0% sensitivity, 90.9% specificity, 81.0% positive predictive value and 93.0% negative predictive value for detecting prerecipient twins. Recipient twins complicated with TTTS have characteristic alterations in time intervals and VTIs of DV Doppler flow, which is present even before fulfilling the TTTS criteria. Furthermore, VTI-2 >45.5% is a possible predictive parameter for TTTS in the second trimester.