Bejar R, Vigliocco G, Gramajo H, Solana C, Benirschke K, Berry C, Coen R, Resnik R
Department of Pediatrics, University of California, San Diego 92103-998.
Am J Obstet Gynecol. 1990 May;162(5):1230-6. doi: 10.1016/0002-9378(90)90024-2.
Necrosis of the cerebral white matter may be identified in living infants with echoencephalography. Echoencephalographic studies were performed in 89 twins and 12 triplets at less than 36 weeks of gestation to determine the incidence and complications associated with antenatal necrosis of the cerebral white matter. Antenatal necrosis of the cerebral white matter was identified when brain atrophy or cavities in the white matter were present by day 3 of life. Fourteen infants (13.8%) were considered to have antenatal necrosis of the cerebral white matter. The incidence of antenatal necrosis of the cerebral white matter was higher in monochorionic than in dichorionic infants (30% vs 3.3%; p less than 0.001). Univariate analysis showed that antenatal necrosis of the cerebral white matter was significantly associated with polyhydramnios, intrauterine fetal death of the cotwin, hydrops, multiple placental vascular connections, and placental artery-to-artery, vein-to-vein, and artery-to-vein anastomosis. Logistic regression analysis showed that antenatal necrosis of the cerebral white matter was predicted by the presence of either artery-to-artery or vein-to-vein anastomosis and by intrauterine fetal death of a cotwin. Vein-to-vein anastomosis had the strongest association, because 89% of seven infants with vein-to-vein anastomosis demonstrated antenatal necrosis of the cerebral white matter (p = 0.003). Monochorionic multiple gestations frequently are complicated by antenatal necrosis of the cerebral white matter. Multiple vascular connections with vein-to-vein anastomosis appear as the most important associated factor for antenatal necrosis of the cerebral white matter in this population.
通过脑回声图检查可在存活的婴儿中发现脑白质坏死。对89例双胞胎和12例三胞胎在妊娠不足36周时进行了脑回声图研究，以确定与产前脑白质坏死相关的发生率及并发症。当在出生后第3天时出现脑萎缩或白质空洞时，可确定为产前脑白质坏死。14例婴儿（13.8%）被认为患有产前脑白质坏死。单绒毛膜婴儿的产前脑白质坏死发生率高于双绒毛膜婴儿（30%对3.3%；P<0.001）。单因素分析显示，产前脑白质坏死与羊水过多、双胎之一的宫内胎儿死亡、水肿、多个胎盘血管连接以及胎盘动脉-动脉、静脉-静脉和动脉-静脉吻合显著相关。逻辑回归分析显示，产前脑白质坏死可通过动脉-动脉或静脉-静脉吻合的存在以及双胎之一的宫内胎儿死亡来预测。静脉-静脉吻合的相关性最强，因为7例有静脉-静脉吻合的婴儿中有89%表现出产前脑白质坏死（P = 0.003）。单绒毛膜多胎妊娠常并发产前脑白质坏死。在这一人群中，具有静脉-静脉吻合的多个血管连接似乎是产前脑白质坏死最重要的相关因素。
