Hack K E A, Kaandorp J J, Derks J B, Elias S G, Pistorius L, Visser G H A
Department of Obstetrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
Ultrasound Obstet Gynecol. 2008 Jun;31(6):662-8. doi: 10.1002/uog.5363.
To investigate the predictive value of abnormal umbilical artery Doppler findings on outcome in uncomplicated monochorionic (MC) twin pregnancies.
Sixty-seven MC twin pregnancies, with antenatal care and delivery at the University Medical Center, Utrecht, The Netherlands, between 1999 and 2004, were studied. Pregnancies with antenatal signs of twin-to-twin transfusion syndrome were excluded. We analyzed the data according to both the last Doppler measurement of the umbilical artery before delivery and the presence of any abnormal Doppler measurement during the course of pregnancy. Risks of mortality and total neonatal morbidity were stratified according to the Doppler findings in one or both fetuses at the time of each standard ultrasound assessment in order to estimate the risk associated with an abnormal Doppler finding at or before that specific gestational age.
Mortality rates were similar in the normal and abnormal Doppler groups. Using both group definitions, total neonatal morbidity was higher in the abnormal Doppler group; this was significant at > 32 weeks' gestation, and was due to lower birth weight and earlier gestational age at delivery. There was no mortality at > or = 36 weeks in the abnormal Doppler group, but there were four perinatal deaths in the normal Doppler group. Gestational age at delivery was significantly lower when one or more abnormal Doppler findings had been present (median, 34 + 1 weeks vs. 36 + 3 weeks) and infants with abnormal Doppler findings weighed on average 261 g (95% CI, 21-502 g) less than those with normal findings.
In MC twins, abnormal Doppler flow of the umbilical artery identifies a subgroup at risk for preterm delivery, low birth weight and neonatal morbidity, but with a similar mortality risk to those with normal Doppler flow. At term, mortality occurred only in the group with normal Doppler findings, suggesting that fetal surveillance is insufficient in uncomplicated term MC twin pregnancies.
探讨单纯性单绒毛膜（MC）双胎妊娠中脐动脉多普勒异常结果对妊娠结局的预测价值。
对1999年至2004年间在荷兰乌得勒支大学医学中心接受产前检查并分娩的67例MC双胎妊娠进行研究。排除有双胎输血综合征产前体征的妊娠。我们根据分娩前脐动脉的最后一次多普勒测量以及孕期中任何异常多普勒测量结果来分析数据。在每次标准超声评估时，根据一个或两个胎儿的多普勒检查结果对死亡风险和新生儿总发病率进行分层，以估计在该特定孕周或之前出现异常多普勒检查结果相关的风险。
正常和异常多普勒组的死亡率相似。使用两种分组定义，异常多普勒组的新生儿总发病率较高；在孕周>32周时差异有统计学意义，且是由于出生体重较低和分娩时孕周较早所致。异常多普勒组在孕周≥36周时无死亡病例，但正常多普勒组有4例围产儿死亡。当出现一个或多个异常多普勒检查结果时，分娩时的孕周显著较低（中位数为34 + 1周 vs. 36 + 3周），且异常多普勒检查结果的婴儿平均体重比正常检查结果的婴儿轻261 g（95%CI，21 - 502 g）。
在MC双胎中，脐动脉异常多普勒血流可识别出早产、低出生体重和新生儿发病风险较高的亚组，但与正常多普勒血流者的死亡风险相似。足月时，死亡仅发生在多普勒检查结果正常的组中，这表明单纯性足月MC双胎妊娠的胎儿监测不足。
