2022 Fiscal Year Final Research Report

Analysis of mechanism of fetal cardiovascular failure in monochorionic twin pregnancies

Research Project

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Project/Area Number	19K09788
Research Category	Grant-in-Aid for Scientific Research (C)
Allocation Type	Multi-year Fund
Section	一般
Review Section	Basic Section 56040:Obstetrics and gynecology-related
Research Institution	Toho University
Principal Investigator	Nakata Masahiko 東邦大学, 医学部, 教授 (10294646)
Co-Investigator(Kenkyū-buntansha)	日根幸太郎東邦大学, 医学部, 講師 (50729308) 早田英二郎東邦大学, 医学部, 講師 (50804176) 與田仁志東邦大学, 医学部, 特任教授 (90589053)
Project Period (FY)	2019-04-01 – 2023-03-31
Keywords	双胎間輸血症候群 / 一絨毛膜双胎 / 双胎妊娠 / 脳性麻痺 / 胎児治療
Outline of Final Research Achievements	We conducted a study to elucidate the pathogenesis of fetal circulatory failure in complications such as twin-to-twin transfusion syndrome and selective fetal growth restrction in monochorionic twins. We performed laser coagulation of placental anastomosis by fetoscope to twin-to-twin transfusion syndrome and selective fetal growth restrction, and examined the changes before and after the procedure. We also compared the results with those of twins who had not yet developed these conditions. The measurement of fetal cardiac function using ultrasound equipment and fetal venous blood flow waveforms revealed that cardiac diastolic function was decreased from early onset in twin-to-twin transfusion syndromes. Aldosterone levels in amniotic fluid also differed between the two fetuses, even in non-TTTS, indicating a unique state of circulatory failure in these twins.
Free Research Field	産科婦人科学
Academic Significance and Societal Importance of the Research Achievements	これまで未解明だった一絨毛膜双胎における双胎間輸血症候群の循環動態が明らかとなった。特に胎児循環不全に進展する以前からすでに胎児心拡張能が障害されていることが明らかとなったことは新たな知見であるとともに、双胎間輸血症候群の早期発見や発症予知につながる有用な情報である。また、双胎間輸血症候群未発症の一絨毛膜双胎でもすでに羊水中アルドステロンレベルに格差を認めることから、二絨毛膜双胎とは異なる循環評価の必要性が示唆された。脳性麻痺や周産期死亡につながるこれらの疾患に対する病態解明や早期発見の可能性が拡大することは、少子化社会において広く国民に資する結果といえる。