Gaziano E P, Gaziano C, Terrell C A, Hoekstra R E
Perinatal Center, Abbott Northwestern Hospital, Department of Obstetrics and Gynecology, University of Minnesota, Minneapolis, Minnesota 55407, USA.
J Matern Fetal Med. 2001 Dec;10(6):371-5. doi: 10.1080/714052776.
Neonatal outcome in twins was studied in relation to the cerebroplacental ratio (CPR).
Seventy-five infants from twin pregnancies with fetal Doppler data obtained within 3 weeks of delivery were candidates for study (23 infants from diamnionic monochorionic and 52 infants from diamnionic dichorionic twin pregnancies). Multivariate regression analyses were expanded to include 114 twin infants (34 diamnionic monochorionic and 80 diamnionic dichorionic twins). Patients with twin transfusion syndrome were excluded from analysis in the monochorionic group. Targeted ultrasound examination with biometry was performed, and Doppler resistance index (RI) of the umbilical artery (UA) and the middle cerebral artery (MCA) were obtained, and the CPR, a measure of blood flow redistribution, was calculated. Outcome variables included major complications, growth restriction, days of ventilator and oxygen use, days in the neonatal intensive care unit and length of stay.
The CPR was correlated more highly with adverse outcomes such as birth weight, special-care nursery days and length of stay than were the UA RI or the MCA RI. The CPR was significantly lower in monochorionic compared with dichorionic twins (1.12 vs. 1.27, p = 0.01). Multivariate regression analyses conducted separately on each twin group also demonstrated that CPR was superior to UA RI and MCA RI in predicting length of stay and restricted growth. Among the Doppler variables, the CPR showed the highest sensitivity for growth restriction (67%).
In twins, CPR was superior to UA RI and MCA RI in predicting adverse neonatal events.
研究双胎妊娠的新生儿结局与脑胎盘比率（CPR）之间的关系。
75例双胎妊娠婴儿在分娩前3周内获得了胎儿多普勒数据，符合研究条件（23例来自双羊膜单绒毛膜双胎妊娠，52例来自双羊膜双绒毛膜双胎妊娠）。多变量回归分析扩展至114例双胎婴儿（34例双羊膜单绒毛膜双胎和80例双羊膜双绒毛膜双胎）。单绒毛膜组中排除双胎输血综合征患者后进行分析。进行了有针对性的超声生物测量检查，获取脐动脉（UA）和大脑中动脉（MCA）的多普勒阻力指数（RI），并计算CPR（一种血流再分布的测量指标）。结局变量包括主要并发症、生长受限、呼吸机使用天数和吸氧天数、新生儿重症监护病房住院天数以及住院时长。
与UA RI或MCA RI相比，CPR与出生体重、特殊护理病房住院天数和住院时长等不良结局的相关性更高。与双绒毛膜双胎相比，单绒毛膜双胎的CPR显著更低（1.12对1.27，p = 0.01）。对每个双胎组分别进行的多变量回归分析还表明，在预测住院时长和生长受限时，CPR优于UA RI和MCA RI。在多普勒变量中，CPR对生长受限的敏感性最高（67%）。
在双胎妊娠中，CPR在预测不良新生儿事件方面优于UA RI和MCA RI。
