Twin-a-māhoe transfusion maʻi pale

ʻO ka mahoe-i-māhoe transfusion maʻi maʻi kahi ʻano maʻamau i loaʻa wale i nā māhoe like ʻoiai lākou i ka ʻōpū.

Hana ʻia ʻo Twin-to-māhoe transfusion syndrome (TTTS) ke neʻe ke koko i hoʻokahi māhoe i kekahi ʻē aʻe ma o ka placenta kaʻana like. ʻO ka māhoe i lilo ke koko i kapa ʻia ka māhoe donor. ʻO ka māhoe i loaʻa ke koko i kapa ʻia ʻo ka māhoe mea loaʻa.

Loaʻa paha nā pilikia i nā pēpē ʻelua, kaukaʻi ʻia i ka nui o ke kahe o ke koko mai kekahi a i kekahi. Heʻuʻuku paha ke koko o ka māhoe mea hāʻawi, a ʻo ka lua paha i nui ke koko.

ʻO ka hapa nui o ka manawa, ʻoi aku ka liʻiliʻi o ka māhoe mea hāʻawi ma mua o ka māhoe ʻē aʻe i ka wā hānau. Loaʻa ka anemia i ka pēpē, hoʻomaloʻo ʻia, a mae ke nānā.

Hānau ʻia ka māhoe o ka mea loaʻa, me ka ʻulaʻula i ka ʻili, nui loa ke koko, a me ke kiʻekiʻe o ke koko. ʻO ka māhoe i loaʻa i ke koko he nui e hoʻomohala i ka maikaʻi ʻole o ka naʻau no ka nui o ke koko. Pono paha i ka pēpē i ka lāʻau e hoʻoikaika ai i ka hana o ka naʻau.

ʻO ka nui kaulike ʻole o nā māhoe like i kapa ʻia he mau māhoe discordant.

Hoʻomaopopo pinepine ʻia kēia ʻano e ultrasound i ka wā hāpai.

Ma hope o ka hānau ʻana, e loaʻa i nā pēpē nā hōʻike aʻe:

• Ke hoʻopaʻa nei i nā hoʻopaʻa ʻana i ke koko, me ka manawa prothrombin (PT) a me ka manawa thromboplastin hapa (PTT)
• Pākuʻi metabolic piha e hoʻoholo ai i ke kaulike electrolyte
• Helu piha koko
• Pākuʻi x-ray

Hoʻomaʻamaʻa paha ka lāʻau i ka amniocentesis hou i ka wā hāpai. Hana ʻia paha ke kaha ʻana o ka kukuna fetal e hoʻopau i ke kahe o ke koko mai kekahi māhoe a i kekahi i ka wā hāpai.

Ma hope o ka hānau ʻana, pili ka mālama ʻana i nā ʻōuli o ke pēpē. Pono ka māhoe donor i kahi kōpili koko e mālama ai i ka anemia.

Pono paha ka māhoe e loaʻa i ka nui o ka wai e hoʻoemi ʻia. Pili paha kēia i kahi transfusion exchange.

Pono nō hoʻi ka māhoe e lawe i ka lāʻau e pale ai i ka hōʻeha o ka puʻuwai.

Inā akahai ka pālua-i-māhoe transfusion, hoʻi pinepine nā pēpē ʻelua. ʻO nā hihia koʻikoʻi paha ka hopena i ka make o kahi māhoe.

TTTS; Syndrome transfusion Fetal

Malone FD, Dʻalton ME. Nā hana he nui: nā ʻano olakino a me ka hoʻokele. I: Resnik R, Lockwood CJ, Moore TR, Greene MF, Copel JA, Silver RM, eds. ʻO Medicine a Maternal-Fetal a Creasy a me Resnik: Nā Manaʻo a me ka Hoʻomeheu. 8th ed. Piladelapia, PA: Elsevier; 2019: chap 40.

Newman RB, Unal ER. Nā hāmeʻa lehulehu. I: Gabbe SG, Niebyl JR, Simpson JL, et al, eds. Nā Obstetrics: Nā Pregnancies Maʻamau a me nā pilikia. ʻEpekema 7 Piladelapia, PA: Elsevier; 2017: chap 32.

ʻO Obican SG, ʻo Odibo AO. Hoʻoikaika fetal invasive. I: Resnik R, Lockwood CJ, Moore TR, Greene MF, Copel JA, Silver RM, eds. ʻO Medicine a Maternal-Fetal a Creasy a me Resnik: Nā Manaʻo a me ka Hoʻomeheu. 8th ed. Piladelapia, PA: Elsevier; 2019: chap 37.