Fetofetal Transfusion

胎儿输血
  • 文章类型: Journal Article
    目的:胎儿镜下激光光凝(FLP)是妊娠16至26周双胎输血综合征(TTTS)的一种行之有效的治疗方法。目前缺乏关于早期(16周之前和16至18周之间)和晚期(26周后)TTTS的最佳临床管理的有力科学证据和统一指南。这项研究的目的是建立一个基于专家的结构化临床共识,以管理早期和晚期TTTS。
    方法:一个国际专家小组进行了Delphi程序,以就临床管理达成共识。参与者是根据他们的临床专业知识选择的,从属关系,和相关出版物。启动了四轮Delphi调查。问卷是使用SurveyMonkey发送的,一个在线调查平台,回复是匿名收集的。在第一轮中,一个核心专家组被要求回答关于适应症的开放式问题,早期和晚期TTTS的治疗时机和模式。在接下来的两轮中,参与者被要求在Likert量表(1-5)上对每个陈述进行评分,并添加任何建议或修改.在每一轮结束时,计算每个语句的中位数得分.中位数为5级而没有更改建议的陈述被接受为共识。中位数低于四级的陈述被认为是非共识,并从Delphi中排除。根据建议修改了中位数为四级的陈述,并在下一轮中重新考虑。在最后一轮,参与者被要求同意或不同意的声明,超过70%的同意而没有更改建议的声明被认为是共识。
    结果:共有122名学者临床医生符合入选标准并被邀请参加。53人同意参加这项研究。其中,75.4%完成了所有四轮比赛。经过四轮,就早期和晚期TTTS的最佳管理达成了共识。对于选定的病例,可以最早在妊娠15周时提供FLP。在妊娠16到18周之间,应根据多普勒严重程度调整管理。FLP可以被认为是长达28周的妊娠。
    结论:Delphi方法允许构建普遍同意的早期和晚期TTTS治疗方案。然而,该协议可以由运营商自行决定修改,和他们的经验,并根据每个案例的具体情况量身定制。这应该提高未来研究的质量,指导临床实践,改善病人护理。本文受版权保护。保留所有权利。
    Fetoscopic laser photocoagulation (FLP) is a well-established treatment for twin-twin transfusion syndrome (TTTS) between 16 and 26 weeks\' gestation. High-quality evidence and guidelines regarding the optimal clinical management of very early (prior to 16 weeks), early (between 16 and 18 weeks) and late (after 26 weeks) TTTS are lacking. The aim of this study was to construct a structured expert-based clinical consensus for the management of early and late TTTS.
    A Delphi procedure was conducted among an international panel of experts. Participants were chosen based on their clinical expertise, affiliation and relevant publications. A four-round Delphi survey was conducted using an online platform and responses were collected anonymously. In the first round, a core group of experts was asked to answer open-ended questions regarding the indications, timing and modes of treatment for early and late TTTS. In the second and third rounds, participants were asked to grade each statement on a Likert scale (1, completely disagree; 5, completely agree) and to add any suggestions or modifications. At the end of each round, the median score for each statement was calculated. Statements with a median grade of 5 without suggestions for change were accepted as the consensus. Statements with a median grade of 3 or less were excluded from the Delphi process. Statements with a median grade of 4 were modified according to suggestions and reconsidered in the next round. In the last round, participants were asked to agree or disagree with the statements, and those with more than 70% agreement without suggestions for change were considered the consensus.
    A total of 122 experts met the inclusion criteria and were invited to participate, of whom 53 (43.4%) agreed to take part in the study. Of those, 75.5% completed all four rounds. A consensus on the optimal management of early and late TTTS was obtained. FLP can be offered as early as 15 weeks\' gestation for selected cases, and can be considered up to 28 weeks. Between 16 and 18 weeks, management should be tailored according to Doppler findings.
    A consensus-based treatment protocol for early and late TTTS was agreed upon by a panel of experts. This protocol should be modified at the discretion of the operator, according to their experience and the specific demands of each case. This should advance the quality of future studies, guide clinical practice and improve patient care. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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  • 文章类型: Practice Guideline
    该指南回顾了正常和复杂的单绒毛膜双胎妊娠的循证管理。
    单绒毛膜双胎或更高阶多胎妊娠的妇女。
    实施这些建议应改善复杂和不复杂的单绒毛膜(和高阶多胎)双胎妊娠的管理。他们将帮助用户适当监测单绒毛膜双胎妊娠,并及时最佳地识别和管理单绒毛膜双胎并发症,从而降低围产期发病率和死亡率。与双绒毛膜双胞胎相比,这些建议需要对单绒毛膜双胞胎进行更频繁的超声监测。
    通过使用适当的MeSH标题(Twins,单卵型;超声检查,产前;胎盘;胎儿输血;胎儿死亡;胎儿生长迟缓)。结果仅限于系统评价,随机对照临床试验,和观察性研究。没有日期限制,但结果仅限于英语或法语材料。
    内容和建议由主要作者起草并达成一致。SOGC理事会批准了最终草案以供出版。作者使用“建议分级评估”对证据质量和建议强度进行了评估,开发和评估(等级)方法。见在线附录A(表A1的定义和A2的强和条件[弱]建议的解释)。
    母胎医学专家,产科医生,放射科医生,超声波检查者,家庭医生,护士,助产士,居民,和其他医疗保健提供者照顾单绒毛膜双胎或更高阶多胎妊娠的妇女。
    加拿大(SOGC)诊断指南,单绒毛膜双胎妊娠并发症的超声监测和管理,包括TTTS,TAPS,sFGR(sIUGR),无心(TRAP),单羊膜双胞胎和一个MC双胞胎的子宫内死亡。
    建议。
    This guideline reviews the evidence-based management of normal and complicated monochorionic twin pregnancies.
    Women with monochorionic twin or higher order multiple pregnancies.
    Implementation of these recommendations should improve the management of both complicated and uncomplicated monochorionic (and higher order multiple) twin pregnancies. They will help users monitor monochorionic twin pregnancies appropriately and identify and manage monochorionic twin complications optimally in a timely manner, thereby reducing perinatal morbidity and mortality. These recommendations entail more frequent ultrasound monitoring of monochorionic twins compared to dichorionic twins.
    Published literature was retrieved through searches of PubMed and the Cochrane Library using appropriate MeSH headings (Twins, Monozygotic; Ultrasonography, Prenatal; Placenta; Fetofetal Transfusion; Fetal Death; Fetal Growth Retardation). Results were restricted to systematic reviews, randomized controlled clinical trials, and observational studies. There were no date limits, but results were limited to English or French language materials.
    The content and recommendations were drafted and agreed upon by the principal authors. The Board of the SOGC approved the final draft for publication. The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations).
    Maternal-fetal medicine specialists, obstetricians, radiologists, sonographers, family physicians, nurses, midwives, residents, and other health care providers who care for women with monochorionic twin or higher order multiple pregnancies.
    Canadian (SOGC) guidelines for the diagnosis, ultrasound surveillance and management of monochorionic twin pregnancy complications, including TTTS, TAPS, sFGR (sIUGR), acardiac (TRAP), monoamniotic twins and intrauterine death of one MC twin.
    RECOMMENDATIONS.
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  • 文章类型: Consensus Development Conference
    Twin anemia-polycythemia sequence (TAPS) is associated with increased perinatal morbidity and mortality. Inconsistencies in the diagnostic criteria for TAPS exist, which hinder the ability to establish robust evidence-based management or monitoring protocols. The main aim of this study was to determine, by expert consensus using a Delphi procedure, the key diagnostic features and optimal monitoring approach for TAPS.
    A Delphi process was conducted among an international panel of experts on TAPS. Panel members were provided with a list of literature-based parameters for diagnosing and monitoring TAPS. They were asked to rate the importance of the parameters on a five-point Likert scale. Consensus was sought to determine the cut-off values for accepted parameters, as well as parameters used in the monitoring of and assessment of outcome in twin pregnancy complicated by TAPS.
    A total of 132 experts were approached. Fifty experts joined the first round, of whom 33 (66%) completed all three rounds. There was agreement that the monitoring interval for the development of TAPS should be every 2 weeks and that the severity should be assessed antenatally using a classification system based on middle cerebral artery (MCA) peak systolic velocity (PSV), but there was no agreement on the gestational age at which to start monitoring. Once the diagnosis of TAPS is made, monitoring should be scheduled weekly. For the antenatal diagnosis of TAPS, the combination of MCA-PSV ≥ 1.5 MoM in the anemic twin and ≤ 0.8 MoM in the polycythemic twin was agreed. Alternatively, MCA-PSV discordance ≥ 1 MoM can be used to diagnose TAPS. Postnatally, hemoglobin difference ≥ 8 g/dL and intertwin reticulocyte ratio ≥ 1.7 were agreed criteria for diagnosis of TAPS. There was no agreement on the cut-off of MCA-PSV or its discordance for prenatal intervention. The panel agreed on prioritizing perinatal and long-term survival outcomes in follow-up studies.
    Consensus-based diagnostic features of TAPS, as well as cut-off values for the parameters involved, were agreed upon by a panel of experts. Future studies are needed to validate these diagnostic features before they can be used in clinical trials of interventions. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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  • 文章类型: Editorial
    Because they share a common placenta, monochorionic gestations are subject to unique pregnancy complications that can threaten the life and health of both fetuses and therefore impose a disproportionate disease burden on overall perinatal morbidity and mortality. Early detection of these unique disease processes may allow for prompt referral to a regional treatment center, comprehensive counseling, and better patient outcomes. The North American Fetal Therapy Network is a consortium of 30 medical institutions in the United States and Canada with established expertise in fetal surgery and other forms of multidisciplinary care for complex fetal disorders. The goal of this publication is to briefly describe complications of monochorionic gestations and to provide multidisciplinary, evidence-based, and consensus-driven recommendations for surveillance of uncomplicated monochorionic gestations.
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