Fetal hypertension: an insight into the pathogenesis of the twin–twin transfusion syndrome

Prenatal Diagnosis - Tập 23 Số 8 - Trang 640-645 - 2003
D. Mahieu‐Caputo1,2, Laurent Salomon2, J. Le Bidois3,4, L Fermont4, Anne Brunhes5, Philippe Jouvet6, Yves Dumez2, Marc Dommergues2
1Maternité, Hôpital Bichat, AP-HP and Université Paris VII, Paris, France
2Maternité, Hôpital Necker-Enfants Malades, AP-HP and Université Paris V, Paris, France
3Service de cardiologie pédiatrique, Hôpital Necker-Enfants Malades, AP-HP and Université Paris V, Paris, France
4Service de cardiologie pédiatrique, Institut de Puériculture de Paris, Paris, France
5Service de Néonatologie, Hôpital Port Royal, AP-HP and Université Paris V, Paris, France
6Service de Réanimation pédiatrique, Hôpital Necker, AP-HP and Université Paris V, Paris, France

Tóm tắt

AbstractObjectivesTo investigate if systemic hypertension occurs in fetuses with twin‐to‐twin transfusion syndrome (TTTS).MethodsWe conducted an observational cohort study in a tertiary care centre in 23 pregnant women with TTTS. Polyhydramnios stuck twin sequence occurred at a median gestational age of 22 weeks (range 15–27). Biventricular myocardial hypertrophy was diagnosed in 22/23 recipient fetuses. In cases with atrioventricular valve regurgitation (AVR), it was possible to estimate the fetal systolic systemic blood pressure by ultrasound, on the basis of the simplified Bernouilli equation. The diagnosis of fetal hypertension (FHT) was made when the estimated systolic arterial pressure was equal to or above 1.6‐fold the expected value.ResultsIn 10 pregnancies (group A), fetal blood pressure could be assessed in recipients with AVR. The maximum velocities ranged from 2.9 to 5 m/s, leading to estimates of systemic fetal arterial pressure from 37 to 104 mmHg, that is, 1.6‐ to 2.8‐fold the expected values. In 13 pregnancies (group B), fetal blood pressure could not be assessed in the absence of AVR. In group A, perinatal death (16/20) and hydrops (7/20) were significantly more frequent than in group B (8/26 and 1/26 respectively).ConclusionFetal systemic hypertension may occur in recipient twins and could play a role in the pathophysiology of TTTS. Copyright © 2003 John Wiley & Sons, Ltd.

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Prenatal Diagnosis

Tập 23 Số 8

640-645

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