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Fetofetales Transfusionssyndrom

Überwachung und Therapie

Twin to twin transfusion syndrome

Monitoring and treatment

  • Zum Thema
  • Published:
Der Gynäkologe Aims and scope

Zusammenfassung

Bei monochorialen Zwillingsschwangerschaften liegt das Risiko für die Entwicklung eines fetofetalen Transfusionssyndroms zwischen 10 und 20%. Durch die Anwendung von hoch auflösenden Ultraschallgeräten gelingt eine sichere Einordnung der Plazentationsverhältnisse. Dabei hat sich das Lambda-Zeichen für die dichoriale und das T-Zeichen für die monochoriale Plazenta als wichtiges diagnostisches Kriterium am Ende des 1. Trimenons etabliert. Sonographische Leitkriterien für ein fetofetales Transfusionssyndrom sind Monochorionizität, gleiches Geschlecht, Ausbildung eines massiven Polyhydramnions und prall gefüllte Harnblase beim Akzeptor sowie Oligo-/Anhydramnion mit gering oder gar nicht gefüllter Harnblase beim Donor. Neben seriellen Amniondrainagen setzt sich die fetoskopische Laserbehandlung zur Koagulation von plazentaren Gefäßanastomosen durch. Diese Entwicklung wird durch Untersuchungsergebnisse über die psycho- und neuromotorische Entwicklung im frühen Kindesalter unterstützt, die einen geringeren Behinderungsgrad der Kinder in der Gruppe der Lasertherapie im Vergleich zur Gruppe der Amniondrainage aufweist. Zwillingsschwangerschaften, die durch ein fetofetales Transfusionssyndrom kompliziert sind, sollten an spezialisierten Pränatalzentren behandelt werden.

Abstract

In monochorionic twin pregnancies, the risk of developing a twin to twin transfusion syndrome is between 15 and 20%. Using high-resolution ultrasound machines, sonographic images demonstrate the detailed features of placental development. The lambda sign was established for the diagnosis of dichorionic placenta and the T sign for monochorionic placenta at the end of the first trimester. Other sonographic findings of the twin to twin transfusion syndrome are monochorionicity, same sex, polyhydramnios, permanently filled bladder in the recipient, and oligo/anhydramnios of the donor with a slightly filled or empty bladder. Fetoscopic laser treatment has become an accepted procedure to coagulate the placental anastomoses. This development is supported by actual studies about psycho- and neuromotoric development in early childhood, which shows a lower rate of disabled children in the group receiving laser therapy in comparison to the group undergoing amnioreduction. Twin pregnancies complicated by twin to twin transfusion syndrome should be treated in specialized prenatal centers.

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  1. Frauenklinik, Bürgerhospital Frankfurt am Main e.V. der Dr. Senckenbergischen Stiftung, Frankfurt a. Main

    F. Bahlmann

  2. Frauenklinik, Bürgerhospital Frankfurt am Main e.V. der Dr. Senckenbergischen Stiftung, Nibelungenallee 37–41, 60318 , Frankfurt am Main

    F. Bahlmann

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Bahlmann, F. Fetofetales Transfusionssyndrom. Gynäkologe 37, 725–736 (2004). https://doi.org/10.1007/s00129-004-1567-y

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  • DOI: https://doi.org/10.1007/s00129-004-1567-y

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