Twin-twin transfusion syndrome: a frequently missed diagnosis with important consequences
Twin-twin transfusion syndrome: a frequently missed diagnosis with important consequences
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DOI：
10.1002/uog.13328
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发表时间：
2014-08-01
影响因子：
7.1
通讯作者：
Ryan, G.
中科院分区：
文献类型：
--
作者：
Baud, D.;Windrim, R.;Ryan, G.
目的探讨双胎输血综合征（TTTS）误诊的发生率及后果。方法回顾性分析单绒毛膜双胎妊娠合并TTTS经胎儿镜激光消融治疗的绒毛膜性及转诊诊断。“误诊”病例，定义为在转诊前未能正确识别绒毛膜性和/或诊断TTTS，与绒毛膜性和TTTS被正确诊断的病例进行比较。比较TTTS分期、转诊时胎龄、总生存率、胎儿和围产儿死亡率、分娩时胎龄、手术时间和产妇并发症。结果33%（107/323）的转诊患者未能识别单毛性和/或TTTS。与正确诊断出绒毛膜性和TTTS的病例相比，误诊患者转诊时疾病更晚期（IV期TTTS: 16.8% vs 7.9%, P = 0.014）和妊娠后期（激光孕周：20.9周vs 20.1周，P = 0.018）。她们的早产率更高（30.3周vs 31.5周，P = 0.04），胎儿和新生儿死亡率更高（7天内新生儿死亡率：19.6% vs 6.0%, P < 0.001）。当诊断不正确时，主要的产妇并发症和重症监护病房入院率增加。结论妊娠前三个月对绒毛膜性的认识不佳可能导致超声随访不充分（未能每2周评估一次）和患者教育。早期准确识别绒毛膜性和TTTS，及时转诊到胎儿治疗中心，是确保最佳母婴结局的关键。版权所有2014isuog由John Wiley & Sons Ltd出版。
Objective To evaluate the incidence and consequences of 'misdiagnosed' cases of twin-twin transfusion syndrome (TTTS).Methods Chorionicity and referral diagnoses were reviewed in pregnant women with monochorionic twin pregnancies complicated by TTTS treated with fetoscopic laser ablation. 'Misdiagnosed' cases, defined as failure to correctly identify chorionicity and/or to diagnose TTTS prior to referral, were compared with cases in whom chorionicity and TTTS were diagnosed correctly. TTTS stage, gestational age at referral, overall survival, fetal and perinatal mortality, gestational age at delivery, operating time and maternal complications were compared.Results Failure to identify monochorionicity and/or TTTS was observed in 33% (107/323) of referrals to our center. Compared with cases in whom chorionicity and TTTS were correctly diagnosed, misdiagnosed patients were referred at a more advanced stage of disease (Stage IV TTTS: 16.8% vs 7.9%, P = 0.014) and later in pregnancy (gestational age at laser: 20.9 weeks vs 20.1 weeks, P = 0.018). They also delivered more prematurely (30.3 weeks' gestation vs 31.5 weeks' gestation, P = 0.04) and fetal and neonatal mortality were higher (neonatal death within 7 days: 19.6% vs 6.0%, P < 0.001). When the diagnosis was incorrect, major maternal complications and intensive care unit admissions were increased.Conclusions Poor recognition of chorionicity in the first trimester of pregnancy might lead to inadequate ultrasound follow up (failure to assess every 2 weeks) and patient education. Early accurate recognition of both chorionicity and TTTS, with timely referral to a fetal therapy center, are key to ensuring optimal maternal and fetal outcomes. Copyright (C) 2014 ISUOG. Published by John Wiley & Sons Ltd.