Komplexe Pulsationen in der Nabelschnurvene beim feto-fetalen Transfusionssyndrom: prognostische Aussagekraft

Zusammenfassung

Ziel: Pulsatilen Flussmustern in der Nabelschnurvene (NS-V) liegen unterschiedliche Ätiologien zugrunde. Ziel unserer Arbeit war es, Inzidenz und Formen venöser Pulsationen bei monochorialen Mehrlingen mit feto-fetalen Transfusionssyndrom (FFTS) zu untersuchen. Material und Methoden: Fälle mit FFTS zwischen 1999 und 2009 wurden retrospektiv untersucht. Das venöse Flussmuster in einer frei flottierenden Nabelschnurschlinge wurde in „nicht pulsatil“ (NP), „monophasisch“ (MP) und „komplex“ (KP) unterteilt. Nur Doppler vor einer etwaigen Intervention wurden berücksichtigt. Ergebnisse: 56 von 106 Fällen mit FFTS konnten in die Studie eingeschlossen werden. In 62,5 % lag ein Stadium III vor und in 45 Fällen führten wir eine Lasertherapie durch. NP Flussmuster waren häufiger beim Donor (80,4 vs. 28,6 %; p < 0,0001), während der Akzeptor mehr MP (50 vs. 17,9 %; p < 0,0006) und KP (21,4 vs. 1,7 %; p < 0,01) aufwies. Die Mortalität bei den Feten mit KP war am höchsten (KP: 76,9 vs. MP: 42,1 vs. NP: 26,2 %; p < 0,01) sowie auch die Rate an Doppelversterben. Schlussfolgerung: KP sind v. a. beim Akzeptor zu finden und sind mit einer hohen perinatalen Mortalität assoziiert. Das Studium des venösen Flussmusters beim FFTS könnte, ähnlich wie eine aufwendige Echokardiografie, hilfreich sein in der Beratung und Prognoseeinschätzung.

Abstract

Purpose: Umbilical vein pulsations (UV-P) are due to various etiologies. The aim of the present study was to investigate the incidence and type of UV-P in monochorionic twins with twin-twin transfusion syndrome (TTTS). Materials and Methods: TTTS cases diagnosed between 1999 and 2009 were examined retrospectively. The UV flow pattern taken from a free floating loop of the umbilical cord was classified as “non-pulsatile” (NP), “monophasic” (MP) and “complex” (CP). Only Doppler flow analyses prior to intervention were examined. Results: Of 106 cases seen during the study period, 56 cases met the inclusion criteria. Of those, 62.5 % were classified as stage III TTTS, and fetoscopic laser therapy was performed in 45 cases. NP flow patterns were more likely found in the donor twin (80.4 vs. 28.6 %; p < 0.0001), while the incidence of MP (50 vs. 17.9 %; p < 0.0006) and CP flow patterns (21.4 vs. 1.7 %; p < 0.01) was higher in the recipient twin. Moreover, the perinatal mortality was highest in cases with CP (CP: 76.9 vs. MP 42.1 vs. NP: 26.2 %; p < 0.01) as well as the rate of cases with double death. Conclusion: CP patterns are more frequently found in the recipient twin and are associated with a considerably high mortality rate. Studying the umbilical vein flow pattern in TTTS may provide additional information for counseling and prognosis similar to that obtained by expensive fetal echocardiography.

Key words

twin-twin transfusion syndrome - umbilical vein pulsations - Doppler

Literatur

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