复杂单绒毛膜妊娠的心功能和神经发育：目前的证据和临床意义

IF 2.2 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Early human development Pub Date : 2025-02-13 DOI:10.1016/j.earlhumdev.2025.106221

Miriam Lopian , Asma Khalil

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引用次数: 0

摘要

单绒毛膜双胎妊娠的特点是共用胎盘和独特的血管结构，与双绒毛膜和单胎妊娠相比，围产期并发症的风险明显增加。本文综述了单绒毛膜妊娠的三种主要并发症：双胎输血综合征（TTTS）、选择性胎儿生长受限（sFGR）和双胎贫血性红细胞增多症序列（TAPS）的病理生理学、心血管和神经适应性。TTTS破坏血流动力学平衡，导致明显的心功能障碍和增加神经发育损伤（NDI）。在sFGR中，不平等的胎盘共享导致双胞胎之间心血管和神经系统的差异，而TAPS导致慢性贫血和红细胞增多症，并伴有脑损伤的相关风险。胎儿治疗的进步，如胎儿镜激光手术，显著提高了生存率，但长期的后遗症仍然令人担忧。这篇综述强调了专门的产前护理、多学科管理和全面的产后随访对减轻不良后果的重要性。研究结果呼吁进一步研究胎儿适应和损伤的机制，旨在完善诊断工具和治疗策略。

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Cardiac function and neurological development in complicated monochorionic pregnancies: Current evidence and clinical implications

Monochorionic twin pregnancies, characterized by a shared placenta and unique vascular architecture, face significantly elevated risks of perinatal complications compared to dichorionic and singleton pregnancies. This review examines the pathophysiology, cardiovascular, and neurological adaptations in three primary complications of monochorionic pregnancies: Twin-to-Twin Transfusion Syndrome (TTTS), Selective Fetal Growth Restriction (sFGR), and Twin Anemia Polycythemia Sequence (TAPS).

TTTS disrupts hemodynamic balance, leading to distinct cardiac dysfunctions and increased neurodevelopmental injury (NDI). In sFGR, unequal placental sharing induces cardiovascular and neurological disparities between twins, while TAPS causes chronic anaemia and polycythemia with associated risks of brain injury. Advances in fetal therapy, such as fetoscopic laser surgery, have significantly improved survival, yet long-term sequelae remain concerning.

This review emphasizes the importance of specialised prenatal care, multidisciplinary management, and comprehensive postnatal follow-up to mitigate adverse outcomes.

The findings call for further research into the mechanisms of fetal adaptation and injury, aiming to refine diagnostic tools and therapeutic strategies.

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来源期刊

Early human development 医学-妇产科学

CiteScore

4.40

自引率

4.00%

发文量

100

审稿时长

46 days

期刊介绍： Established as an authoritative, highly cited voice on early human development, Early Human Development provides a unique opportunity for researchers and clinicians to bridge the communication gap between disciplines. Creating a forum for the productive exchange of ideas concerning early human growth and development, the journal publishes original research and clinical papers with particular emphasis on the continuum between fetal life and the perinatal period; aspects of postnatal growth influenced by early events; and the safeguarding of the quality of human survival. The first comprehensive and interdisciplinary journal in this area of growing importance, Early Human Development offers pertinent contributions to the following subject areas: Fetology; perinatology; pediatrics; growth and development; obstetrics; reproduction and fertility; epidemiology; behavioural sciences; nutrition and metabolism; teratology; neurology; brain biology; developmental psychology and screening.