在单绒毛膜胎盘血管吻合用有色染料的精确和简单的评价
Summary
双对双胞胎输血症候群和双性贫血真性红细胞增多症序列是两个潜在的破坏性，在围产医学的问题。这两种疾病只发生在单绒毛膜双胞胎和不平衡的血流通过胎盘血管吻合的结果。我们提供了一个简单的协议，准确地评价使用彩色染料注射出生后，胎盘血管的血管吻合的存在。
Abstract
胎盘血管吻合的存在是双对双胞胎输血症候群（TTTS）和双性贫血真性红细胞增多症序列（TAPS）1,2 的发展非必要条件。双胞胎的胎盘注射液的研究表明，这种吻合几乎都是目前在单绒毛膜双胞胎， 双胞胎 1 dichorionic极为罕见。已记录三种类型的吻合：从动脉到动脉，静脉静脉和动脉静脉。动静脉（AV）吻合是单向的，被称为“深”吻合，因为他们继续通过一个共同的胎盘子叶的，而动脉硬化，动脉（AA）和静脉 – 静脉（VV）吻合是双向的，被称为“肤浅”，因为他们的绒毛膜板的谎言。 TTTS和水龙头都引起血流由于影音吻合的双胞胎之间的净不平衡。双胞胎中的一个（捐赠者）的血液通过动脉泵到共享胎盘子叶，然后通过静脉排入其他双胞胎（收件人）的流通。除非血液泵回通过相反指示深AV吻合或通过浅表吻合，从收件人的捐助，发生的血液量不平衡，逐渐导致TTTS或水龙头的发展。机管局吻合的存在已被证明对保护补偿单向AV 吻合 1,2造成循环系统不平衡发展的TTTS和水龙头。单绒毛膜胎盘注射剂在出生后不久是一个有用的平均了解各种（血液）在单绒毛膜双胎的并发症的病因，是必需的测试，以达到诊断的水龙头2。此外，注射fetoscopic激光手术治疗的TTTS的胎盘可以识别可能残留吻合 3-5 。这些额外的信息是至关重要TTTS或水龙头单绒毛膜双胞胎的管理和护理工作的所有perinatologists的。当前正在使用的几个胎盘注射技术。我们提供了一个简单的协议，准确地评价（剩余）使用彩色染料注射血管吻合的存在。
Protocol
1。在胎盘娩出的制备标签（第一出生）或两个（第二个出生的）夹具的双胞胎的脐带。 检查胎盘的完整性或中断的孕产妇和胎儿的表面。 记录以下数据：型线插入（中央，偏心，边际或velamentous），在脐带（通常是一个静脉和动脉，有时只有一条动脉）和两个胎盘股之间的颜色差异的血管的数目。除以膜的一节可以送病理检查，以确认chorionicity类型。 胎盘就可以被?…
Discussion
TTTS和水龙头都可以发生在单绒毛膜双胞胎的两个严重障碍。这两种疾病是由于造成不平衡intertwin血流AV吻合。在过去20年中，fetoscopic激光手术成为被证明是最好的方法治疗TTTS 10 。 fetoscopic激光治疗的目的是通过胎盘表面的血管吻合凝固的跨双循环中断。然而，TTTS激光治疗是远远不够完善。用激光治疗可导致多种并发症，包括宫内胎儿死亡，复发TTTS和水龙头1,4。这些并发症可以?…
Disclosures
The authors have nothing to disclose.
Acknowledgements
没有资金来源。
Materials
| Name of reagent | Company | Catalogue number | Comments |
|---|---|---|---|
| Umbilical catheters (various dimensions, Length 40 cm) | Vygon | 1270.08 (8 F) 1270.08 (5 F) 1270.04 (4 F) 1270.03 (3.5 F) 1270.02 (2.5 F) | Any type of catheter can be used |
| 20 ml syringes | BD Plastipak | 300613 | |
| Color dye (different colors) | Royal Talens Schoolverf | 36716010 (blue)36715010 (green) 36712350 (yellow) 36713570 (pink) | Any viscous color dye can be used |
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Tags
Vascular AnastomosesPlacentaTwin-to-twin Transfusion Syndrome (TTTS)Twin Anemia Polycythemia Sequence (TAPS)Injection StudiesMonochorionic TwinsDichorionic TwinsArtery To Artery AnastomosesVein To Vein AnastomosesArtery To Vein AnastomosesArterio-venous (AV) AnastomosesArterio-arterial (AA) AnastomosesVeno-venous (VV) AnastomosesDeep AnastomosesSuperficial AnastomosesBlood Flow ImbalanceDonor TwinRecipient TwinBlood Volumes Imbalance
Cite This Article
Lopriore, E., Slaghekke, F., Middeldorp, J. M., Klumper, F. J., van Lith, J. M., Walther, F. J., Oepkes, D. Accurate and Simple Evaluation of Vascular Anastomoses in Monochorionic Placenta using Colored Dye. J. Vis. Exp. (55), e3208, doi:10.3791/3208 (2011).