Maiz Nerea, Staboulidou Ismini, Leal Antonio M, Minekawa Ryoko, Nicolaides Kypros H
From the Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, United Kingdom.
Obstet Gynecol. 2009 Apr;113(4):860-865. doi: 10.1097/AOG.0b013e31819c9f66.
To examine the independent contribution of abnormal flow in the ductus venosus at 11 to 13 weeks of gestation in the prediction of adverse pregnancy outcome in relation to chorionicity.
This was a prospective study in 516 dichorionic and 179 monochorionic twin pregnancies in which the fetal ductus venosus flow was assessed at 11 0/7 to 13 6/7 weeks of gestation. The prevalence of reversed a-wave in the fetal ductus venosus was compared between monochorionic and dichorionic pregnancies and between those with and without pregnancy complications. Comparisons between each of the pregnancy outcomes and the normal outcome group and between monochorionic and dichorionic pregnancies were made using the Mann-Whitney U-test for continuous variables and the chi2 test and Fisher exact test for categorical variables.
The prevalence of reversed a-wave in at least one of the fetuses was significantly higher in monochorionic than in dichorionic pregnancies (18.4% compared with 8.3%, P<.001) and in pregnancies complicated by miscarriage (28.6%, P=.005), fetal aneuploidy (70.0%, P<.001), and twin-twin transfusion syndrome (38.5%, P<.001) compared with the pregnancies with two healthy live births (7.7%). Pregnancy outcome was normal in 33 of the 43 (76.7%) dichorionic and in 14 of the 33 (42.4%) monochorionic twins with reversed a-wave in at least one of the fetuses.
In twins, reversed a-wave in the ductus venosus at 11 to 13 weeks of gestation is associated with increased risk for aneuploidies, miscarriage, and development of severe twin-twin transfusion syndrome. However, in about 75% of dichorionic twins and 40% of monochorionic twins with reversed a-wave, the pregnancy outcome is normal.
II.
研究妊娠11至13周时静脉导管血流异常对不同绒毛膜性双胎妊娠不良结局预测的独立贡献。
这是一项前瞻性研究，纳入516例双绒毛膜双胎妊娠和179例单绒毛膜双胎妊娠，于妊娠11⁰/₇至13⁶/₇周评估胎儿静脉导管血流。比较单绒毛膜和双绒毛膜妊娠之间以及有和无妊娠并发症者之间胎儿静脉导管a波反向的发生率。连续变量采用Mann-Whitney U检验，分类变量采用χ²检验和Fisher精确检验，比较各妊娠结局与正常结局组之间以及单绒毛膜和双绒毛膜妊娠之间的差异。
至少一个胎儿出现a波反向的发生率在单绒毛膜妊娠中显著高于双绒毛膜妊娠（分别为18.4%和8.3%，P<0.001），在合并流产（28.6%，P=0.005）、胎儿非整倍体（70.0%，P<0.001）和双胎输血综合征（38.5%，P<0.001）的妊娠中高于有两个健康活产儿的妊娠（7.7%）。43例至少一个胎儿出现a波反向的双绒毛膜双胎中有33例（76.7%）妊娠结局正常，33例单绒毛膜双胎中有14例（42.4%）妊娠结局正常。
双胎妊娠中，妊娠11至13周时静脉导管a波反向与非整倍体、流产及严重双胎输血综合征发生风险增加相关。然而，约75%的双绒毛膜双胎和40%的单绒毛膜双胎a波反向时妊娠结局正常。
II级。
