<?xml version="1.0" encoding="ISO-8859-1"?><cms:container xmlns:cms="http://edoc.hu-berlin.de/diml/module/cms"><cms:document><cms:meta><cms:entry id="front" part="front" ref="front" type="front"/><cms:entry type="title">Vergleich des Nabelschnur-Resistance-Index von monochorialen und dichorialen Geminischwangerschaften</cms:entry><cms:entry type="author">Tilo Burkhardt</cms:entry><cms:entry id="N10047" part="front" ref="N10047" type="pagenumber">3</cms:entry><cms:entry id="N1007D" part="front" ref="N1007D" type="pagenumber">4</cms:entry><cms:entry id="chapter1" part="chapter1" ref="chapter1" type="chapter">1</cms:entry><cms:entry id="N100B5" part="chapter1" ref="N100B5" type="pagenumber">8</cms:entry><cms:entry id="N10116" part="chapter1" ref="N10116" type="pagenumber">9</cms:entry><cms:entry id="chapter2" part="chapter2" ref="chapter2" type="chapter">2</cms:entry><cms:entry id="N1019C" part="chapter2" ref="N1019C" type="pagenumber">10</cms:entry><cms:entry id="N101A6" part="chapter2" ref="N101A6" type="section">2.1</cms:entry><cms:entry id="N101B3" part="chapter2" ref="N101B3" type="section">2.2</cms:entry><cms:entry id="N101BC" part="chapter2" ref="N101BC" type="section">2.3</cms:entry><cms:entry id="N101C0" part="chapter2" ref="N101C0" type="pagenumber">11</cms:entry><cms:entry id="N101C5" part="chapter2" ref="N101C5" type="subsection">2.3.1</cms:entry><cms:entry id="N101D9" part="chapter2" ref="N101D9" type="table"/><cms:entry id="N10271" part="chapter2" ref="N10271" type="pagenumber">12</cms:entry><cms:entry id="N10277" part="chapter2" ref="N10277" type="subsection">2.3.2</cms:entry><cms:entry id="N102B4" part="chapter2" ref="N102B4" type="table"/><cms:entry id="N102EF" part="chapter2" ref="N102EF" type="subsection">2.3.3</cms:entry><cms:entry id="N10321" part="chapter2" ref="N10321" type="pagenumber">13</cms:entry><cms:entry id="N10327" part="chapter2" ref="N10327" type="subsection">2.3.4</cms:entry><cms:entry id="N10331" part="chapter2" ref="N10331" type="table"/><cms:entry id="N10390" part="chapter2" ref="N10390" type="section">2.4</cms:entry><cms:entry id="N103A9" part="chapter2" ref="N103A9" type="table"/><cms:entry id="N10434" part="chapter2" ref="N10434" type="pagenumber">14</cms:entry><cms:entry id="N10464" part="chapter2" ref="N10464" type="table"/><cms:entry id="N104B3" part="chapter2" ref="N104B3" type="section">2.5</cms:entry><cms:entry id="N104B7" part="chapter2" ref="N104B7" type="pagenumber">15</cms:entry><cms:entry id="chapter3" part="chapter3" ref="chapter3" type="chapter">3</cms:entry><cms:entry id="N104DB" part="chapter3" ref="N104DB" type="pagenumber">16</cms:entry><cms:entry id="N104E7" part="chapter3" ref="N104E7" type="section">3.1</cms:entry><cms:entry id="N104EB" part="chapter3" ref="N104EB" type="pagenumber">17</cms:entry><cms:entry id="N104F5" part="chapter3" ref="N104F5" type="table"/><cms:entry id="N10656" part="chapter3" ref="N10656" type="section">3.2</cms:entry><cms:entry id="N1065D" part="chapter3" ref="N1065D" type="table"/><cms:entry id="N10759" part="chapter3" ref="N10759" type="pagenumber">18</cms:entry><cms:entry id="N1075F" part="chapter3" ref="N1075F" type="section">3.3</cms:entry><cms:entry id="N10766" part="chapter3" ref="N10766" type="table"/><cms:entry id="N107FE" part="chapter3" ref="N107FE" type="table"/><cms:entry id="N108D2" part="chapter3" ref="N108D2" type="table"/><cms:entry id="N10A36" part="chapter3" ref="N10A36" type="pagenumber">19</cms:entry><cms:entry id="N10A3C" part="chapter3" ref="N10A3C" type="section">3.4</cms:entry><cms:entry id="N10A41" part="chapter3" ref="N10A41" type="subsection">3.4.1</cms:entry><cms:entry id="N10A4E" part="chapter3" ref="N10A4E" type="mm">579#331</cms:entry><cms:entry id="N10A59" part="chapter3" ref="N10A59" type="table"/><cms:entry id="N10A60" part="chapter3" ref="N10A60" type="pagenumber">20</cms:entry><cms:entry id="N10AF5" part="chapter3" ref="N10AF5" type="table"/><cms:entry id="N10BB8" part="chapter3" ref="N10BB8" type="pagenumber">21</cms:entry><cms:entry id="N10BBC" part="chapter3" ref="N10BBC" type="mm">579#331</cms:entry><cms:entry id="N10BC7" part="chapter3" ref="N10BC7" type="mm">579#331</cms:entry><cms:entry id="N10BD2" part="chapter3" ref="N10BD2" type="pagenumber">22</cms:entry><cms:entry id="N10BD6" part="chapter3" ref="N10BD6" type="mm">579#331</cms:entry><cms:entry id="N10BE1" part="chapter3" ref="N10BE1" type="mm">579#331</cms:entry><cms:entry id="N10BEC" part="chapter3" ref="N10BEC" type="table"/><cms:entry id="N10BF3" part="chapter3" ref="N10BF3" type="pagenumber">23</cms:entry><cms:entry id="N10CB6" part="chapter3" ref="N10CB6" type="subsection">3.4.2</cms:entry><cms:entry id="N10CBD" part="chapter3" ref="N10CBD" type="mm">579#328</cms:entry><cms:entry id="N10CC8" part="chapter3" ref="N10CC8" type="table"/><cms:entry id="N10CCF" part="chapter3" ref="N10CCF" type="pagenumber">24</cms:entry><cms:entry id="N10D68" part="chapter3" ref="N10D68" type="table"/><cms:entry id="N10E2B" part="chapter3" ref="N10E2B" type="pagenumber">25</cms:entry><cms:entry id="N10E2F" part="chapter3" ref="N10E2F" type="mm">579#331</cms:entry><cms:entry id="N10E3A" part="chapter3" ref="N10E3A" type="mm">579#331</cms:entry><cms:entry id="N10E45" part="chapter3" ref="N10E45" type="pagenumber">26</cms:entry><cms:entry id="N10E4E" part="chapter3" ref="N10E4E" type="mm">579#331</cms:entry><cms:entry id="N10E59" part="chapter3" ref="N10E59" type="pagenumber">27</cms:entry><cms:entry id="N10E5D" part="chapter3" ref="N10E5D" type="mm">579#331</cms:entry><cms:entry id="N10E68" part="chapter3" ref="N10E68" type="table"/><cms:entry id="N10F2E" part="chapter3" ref="N10F2E" type="subsection">3.4.3</cms:entry><cms:entry id="N10F37" part="chapter3" ref="N10F37" type="pagenumber">28</cms:entry><cms:entry id="N10F3E" part="chapter3" ref="N10F3E" type="mm">579#331</cms:entry><cms:entry id="N10F49" part="chapter3" ref="N10F49" type="table"/><cms:entry id="N10FDF" part="chapter3" ref="N10FDF" type="pagenumber">29</cms:entry><cms:entry id="N10FE6" part="chapter3" ref="N10FE6" type="table"/><cms:entry id="N110A9" part="chapter3" ref="N110A9" type="mm">579#331</cms:entry><cms:entry id="N110B4" part="chapter3" ref="N110B4" type="pagenumber">30</cms:entry><cms:entry id="N110B8" part="chapter3" ref="N110B8" type="mm">579#331</cms:entry><cms:entry id="N110C8" part="chapter3" ref="N110C8" type="pagenumber">31</cms:entry><cms:entry id="N110CC" part="chapter3" ref="N110CC" type="mm">579#331</cms:entry><cms:entry id="N110D7" part="chapter3" ref="N110D7" type="mm">579#328</cms:entry><cms:entry id="N110E2" part="chapter3" ref="N110E2" type="table"/><cms:entry id="N110E9" part="chapter3" ref="N110E9" type="pagenumber">32</cms:entry><cms:entry id="N111AF" part="chapter3" ref="N111AF" type="subsection">3.4.4</cms:entry><cms:entry id="N111B4" part="chapter3" ref="N111B4" type="block">3.4.4.1</cms:entry><cms:entry id="N111BB" part="chapter3" ref="N111BB" type="table"/><cms:entry id="N113BC" part="chapter3" ref="N113BC" type="pagenumber">33</cms:entry><cms:entry id="_1107541290" part="chapter3" ref="_1107541290" type="link"/><cms:entry id="_1107541447" part="chapter3" ref="_1107541447" type="link"/><cms:entry id="_1109259892" part="chapter3" ref="_1109259892" type="link"/><cms:entry id="N113C9" part="chapter3" ref="N113C9" type="mm">457#304</cms:entry><cms:entry id="N113D7" part="chapter3" ref="N113D7" type="table"/><cms:entry id="N114E8" part="chapter3" ref="N114E8" type="pagenumber">34</cms:entry><cms:entry id="N114F2" part="chapter3" ref="N114F2" type="table"/><cms:entry id="N117FA" part="chapter3" ref="N117FA" type="block">3.4.4.2</cms:entry><cms:entry id="N117FE" part="chapter3" ref="N117FE" type="pagenumber">35</cms:entry><cms:entry id="N11805" part="chapter3" ref="N11805" type="table"/><cms:entry id="N11904" part="chapter3" ref="N11904" type="block">3.4.4.3</cms:entry><cms:entry id="N1190E" part="chapter3" ref="N1190E" type="table"/><cms:entry id="N11915" part="chapter3" ref="N11915" type="pagenumber">36</cms:entry><cms:entry id="N11986" part="chapter3" ref="N11986" type="mm">549#366</cms:entry><cms:entry id="N11991" part="chapter3" ref="N11991" type="subsection">3.4.5</cms:entry><cms:entry id="N11995" part="chapter3" ref="N11995" type="pagenumber">37</cms:entry><cms:entry id="N1199C" part="chapter3" ref="N1199C" type="table"/><cms:entry id="N11C7E" part="chapter3" ref="N11C7E" type="block">3.4.5.1</cms:entry><cms:entry id="N11C82" part="chapter3" ref="N11C82" type="pagenumber">38</cms:entry><cms:entry id="_1107542267" part="chapter3" ref="_1107542267" type="link"/><cms:entry id="_1109260016" part="chapter3" ref="_1109260016" type="link"/><cms:entry id="_1109260313" part="chapter3" ref="_1109260313" type="link"/><cms:entry id="_1109260321" part="chapter3" ref="_1109260321" type="link"/><cms:entry id="_1112517693" part="chapter3" ref="_1112517693" type="link"/><cms:entry id="N11C9B" part="chapter3" ref="N11C9B" type="mm">378#252</cms:entry><cms:entry id="N11CAB" part="chapter3" ref="N11CAB" type="pagenumber">39</cms:entry><cms:entry id="_1107542335" part="chapter3" ref="_1107542335" type="link"/><cms:entry id="_1109260475" part="chapter3" ref="_1109260475" type="link"/><cms:entry id="_1109260621" part="chapter3" ref="_1109260621" type="link"/><cms:entry id="_1109260645" part="chapter3" ref="_1109260645" type="link"/><cms:entry id="_1109273933" part="chapter3" ref="_1109273933" type="link"/><cms:entry id="_1111661620" part="chapter3" ref="_1111661620" type="link"/><cms:entry id="N11CC1" part="chapter3" ref="N11CC1" type="mm">381#253</cms:entry><cms:entry id="_1107542384" part="chapter3" ref="_1107542384" type="link"/><cms:entry id="_1109260696" part="chapter3" ref="_1109260696" type="link"/><cms:entry id="N11CD9" part="chapter3" ref="N11CD9" type="mm">378#252</cms:entry><cms:entry id="chapter4" part="chapter4" ref="chapter4" type="chapter">4</cms:entry><cms:entry id="N11CEC" part="chapter4" ref="N11CEC" type="pagenumber">40</cms:entry><cms:entry id="N11D1D" part="chapter4" ref="N11D1D" type="section">4.1</cms:entry><cms:entry id="N11D21" part="chapter4" ref="N11D21" type="pagenumber">41</cms:entry><cms:entry id="N11D41" part="chapter4" ref="N11D41" type="section">4.2</cms:entry><cms:entry id="N11D45" part="chapter4" ref="N11D45" type="pagenumber">42</cms:entry><cms:entry id="N11D66" part="chapter4" ref="N11D66" type="section">4.3</cms:entry><cms:entry id="N11D83" part="chapter4" ref="N11D83" type="pagenumber">43</cms:entry><cms:entry id="N11D9A" part="chapter4" ref="N11D9A" type="pagenumber">44</cms:entry><cms:entry id="_1111428054" part="chapter4" ref="_1111428054" type="link"/><cms:entry id="_1111428192" part="chapter4" ref="_1111428192" type="link"/><cms:entry id="N11DA4" part="chapter4" ref="N11DA4" type="mm">540#234</cms:entry><cms:entry id="N11DCC" part="chapter4" ref="N11DCC" type="pagenumber">45</cms:entry><cms:entry id="N11DD6" part="chapter4" ref="N11DD6" type="section">4.4</cms:entry><cms:entry id="N11DE2" part="chapter4" ref="N11DE2" type="table"/><cms:entry id="N11EE9" part="chapter4" ref="N11EE9" type="pagenumber">46</cms:entry><cms:entry id="N11F0D" part="chapter4" ref="N11F0D" type="pagenumber">47</cms:entry><cms:entry id="N11F31" part="chapter4" ref="N11F31" type="section">4.5</cms:entry><cms:entry id="N11F5A" part="chapter4" ref="N11F5A" type="pagenumber">48</cms:entry><cms:entry id="N11F7A" part="chapter4" ref="N11F7A" type="pagenumber">49</cms:entry><cms:entry id="N11FBA" part="chapter4" ref="N11FBA" type="pagenumber">50</cms:entry><cms:entry id="N11FF1" part="chapter4" ref="N11FF1" type="section">4.6</cms:entry><cms:entry id="N12001" part="chapter4" ref="N12001" type="pagenumber">51</cms:entry><cms:entry ref="chapter5" type="chapter">5</cms:entry><cms:entry ref="N1201C" type="pagenumber">52</cms:entry><cms:entry id="N1202E" part="N1202E" ref="N1202E" type="abbreviation">
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Literaturverzeichnis</cms:entry><cms:entry id="N12126" part="N12122" ref="N12126" type="pagenumber">53</cms:entry><cms:entry id="_bib56" part="N12122" ref="_bib56" type="citation"/><cms:entry id="_bib57" part="N12122" ref="_bib57" type="citation"/><cms:entry id="_bib76" part="N12122" ref="_bib76" type="citation"/><cms:entry id="_bib25" part="N12122" ref="_bib25" type="citation"/><cms:entry id="_bib55" part="N12122" ref="_bib55" type="citation"/><cms:entry id="_bib77" part="N12122" ref="_bib77" type="citation"/><cms:entry id="_bib82" part="N12122" ref="_bib82" type="citation"/><cms:entry id="_bib69" part="N12122" ref="_bib69" type="citation"/><cms:entry id="_bib58" part="N12122" ref="_bib58" type="citation"/><cms:entry id="_bib79" part="N12122" ref="_bib79" type="citation"/><cms:entry id="_bib59" part="N12122" ref="_bib59" type="citation"/><cms:entry id="_bib92" part="N12122" ref="_bib92" type="citation"/><cms:entry id="_bib32" part="N12122" ref="_bib32" type="citation"/><cms:entry 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Danksagungen</cms:entry><cms:entry id="N12D4E" part="N12D4B" ref="N12D4E" type="pagenumber">61</cms:entry><cms:entry id="N12D5E" part="N12D4B" ref="N12D5E" type="pagenumber">62</cms:entry><cms:entry id="N12D6C" part="N12D6C" ref="N12D6C" type="declaration">Eidesstattliche Erklärung</cms:entry><cms:entry type=":lang">de</cms:entry><cms:entry id=":contents" part="front" ref=":contents" type=":contents">Inhaltsverzeichnis</cms:entry><cms:entry type=":help"><url href="http://...">Hilfe</url></cms:entry></cms:meta><cms:content><chapter id="chapter5" label="5">
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Schlussfolgerung</head>
			<p>Dichoriale Zwillinge zeigen einen signifikanten Abfall des Nabelschnur-Resistance-Index im Verlauf der Schwangerschaft, ähnlich dem Abfall bei Einlingen. Bei den monochorialen Zwillingen ohne FFTS ist dieser Abfall etwas geringer, signifikante Impedanzsprünge gibt es nur zwischen den Wochengruppen &lt;24/24-27 und 28-31/32-35. Monochoriale Zwillinge mit FFTS zeigen nur eine geringe Tendenz hin zu niedrigeren Resistance-Indizes im Verlauf der Schwangerschaft. Signifikante Impedanzsprünge zwischen den Wochengruppen konnten nicht nachgewiesen werden. Innerhalb der Wochengruppen ließen sich keine signifikanten Unterschiede im Resistance-Index der Arteriae umbilicales zwischen den Zwillingen unterschiedlicher Eihautverhältnisse nachweisen.<br/>
Die Inpaardifferenzen der Resistance-Indizes waren bei den Feten der Zwillingspaare mit diagnostizierten FFTS am größten. Die Differenzen waren signifikant höher als bei den Zwillingen mit dichorialen und monochorialen Eihautverhältnissen ohne FFTS. Diese Differenz gibt Auskunft über das Ausmaß der fetofetalen Kreislaufkommunikation der beiden Feten.<br/>
Der Vergleich des Resistance-Index der Feten eines Zwillingspaares mit diagnostizierten FFTS kann zur Einschätzung der Gefährdung der Feten hilfreich sein.<br/>
Es ist nicht sicher geklärt, ob der Nabelschnur-Resistance-Index, gemessen am Nabelschnuransatz am Feten, die Auswirkungen einer Kreislaufkommunikation bei monochorialen Zwillingen auf die Strömung im fetoplazentarem Gefäßsystem ausreichend erfasst. Genauso wenig ist geklärt ob die Existenz von Anastomosen oder erst eine quantitative Bluttransfusion eine messbare Impedanzveränderung in den Arteriae umbilicales bewirkt. Das bedeutet, dass das hämodynamische Problem eines FFTS mittels Dopplersonographie nicht erschöpfend diagnostiziert und bewertet werden kann.</p>
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