Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, USA.
Am J Obstet Gynecol. 2012 Jan;206(1):10-20. doi: 10.1016/j.ajog.2011.06.075. Epub 2011 Jun 25.
Approximately 16% of twin gestations have discordance of at least 20%. We identified 14 risk factors for divergent growth that can be categorized as maternal, fetal, or placental. Determination of chorionicity and serial ultrasound evaluation with a high index of suspicion for divergent growth is required for the diagnosis and stratification of risk. The highest reported likelihood ratio for detection of discordance was 5.9 during the first trimester examination and 6.0 for the second trimester. Although our ability to identify discordant twins is limited, once suspected and at viable gestational age, these pregnancies should have antepartum testing. Discordant growth alone is not an indication for preterm birth. Although there are multiple publications on the increased morbidity and mortality rates with discordant growth, there is a paucity of reports on how to manage them optimally and deliver them in a timely manner.
大约 16%的双胞胎妊娠存在至少 20%的不一致性。我们确定了 14 个导致生长不一致的风险因素，这些因素可以分为母体、胎儿或胎盘因素。为了诊断和分层风险，需要确定绒毛膜性，并对具有生长不一致高度怀疑的胎儿进行系列超声评估。报告的最高比值比用于检测不一致性是在孕早期检查时为 5.9，在孕中期检查时为 6.0。尽管我们识别不一致双胞胎的能力有限，但一旦怀疑存在不一致性且胎儿存活，这些妊娠就应该进行产前检查。不一致性生长本身并不是早产的指征。尽管有许多关于不一致性生长增加发病率和死亡率的出版物，但关于如何最佳管理这些妊娠并及时分娩的报告很少。
