Fetus-Placenta-NewbornNatriuretic peptides in the pathogenesis of cardiac dysfunction in the recipient fetus of twin-twin transfusion syndrome☆
Section snippets
Patients
This observational study of 14 consecutive cases of monochorionic twins with TTTS and 6 without TTTS, was conducted in a tertiary referral center. Monochorionicity was established ultrasonically by (a) concordant genitalia, (b) interfetal membrane thickness of <2.0 mm, and (c) single placental mass, and was confirmed by use of placental histology after birth. Only those cases in which both fetuses were alive at the time of fetal blood sampling (FBS) were included in this study. The inclusion
Results
Clinical features of the two groups are shown in the Table.Parameter TTTS (n = 14) Non-TTTS (n = 6) P value Gestational age at diagnosis (wk) 21 (16-28) Gestational age at FBS (wk) 23 (19-30) 30 (21-34) NS Gestational age at delivery (wk) 27 (21-36) 31 (24-36) NS Maximum AFL (cm) 58 (35-79) 16 (12-24) <.001 No. of amnioreductions 2 (1-8) Total amniotic fluid volume removed (L) 0.7 (.3-20) Δ Hemoglobin at FBS (g/dL) 3
Comment
This study demonstrates elevated levels of natriuretic peptides ANP and BNP in utero in recipient fetuses of TTTS of midtrimester origin. However, we also found that fetal BNP levels were significantly higher in the recipient fetuses with severe cardiac dysfunction than in those with normal function. In contrast, fetal ANP did not show such an association. Our findings are in keeping with the growing recognition in the human adult subjects that plasma BNP is a sensitive marker in physiologic
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Reprint requests: Rekha Bajoria, St Mary's Hospital, Whitworth Park, Manchester M13 OJH, UK. E-mail: [email protected].