Chang Yao-Lung, Chang Shuenn-Dyh, Chao An-Shine, Hsieh Peter C C, Wang Chao-Nin, Wang Tzu-Hao
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Tao-Yuan, Taiwan.
Twin Res Hum Genet. 2012 Oct;15(5):680-4. doi: 10.1017/thg.2012.39. Epub 2012 Jul 3.
This study was designed to evaluate the degree of placenta share discordance in relation to the betamethasone-induced return of positive end-diastolic flow in monochorionic twin pregnancies with selective intrauterine growth restriction (sIUGR) and abnormal umbilical artery Doppler. Monochorionic twins with sIUGR was defined as one twin having an estimated fetal weight below the 10th percentile combined with an estimated fetal weight discordance >25%. The umbilical artery Doppler directly prior to (D0) and 24 hours (D1) and 48 hours (D2) after the first dose of betamethasone administration was recorded. The estimated individual placental weight in monochorionic twins was obtained by cutting the placenta along the vascular equator into two territories; the placenta share discordance was calculated as [(estimated individual placental weight of appropriated for gestational age twin- estimated individual placental weight of growth restricted twin)/estimated individual placental weight of appropriated for gestational age twin] × 100%. Six (23.1%) of the 26 included cases achieved betamethasone-induced return of positive umbilical artery end-diastolic flow. The difference of placenta share discordance and birth weight discordance were not significantly different between twins with and without betamethasone-induced return of positive umbilical artery end-diastolic flow. Thus, according to our study results, it was proposed that although the placenta share discordance correlated with the abnormal umbilical artery Doppler in the IUGR fetus in monochorionic twin, the betamethasone-induced return of positive umbilical artery end-diastolic flow, however, did not reveal the similar relationship with the severity of placenta share discordance.
本研究旨在评估单绒毛膜双胎妊娠合并选择性胎儿生长受限（sIUGR）及脐动脉多普勒异常时，胎盘份额不一致程度与倍他米松诱导的舒张末期血流信号恢复之间的关系。sIUGR的单绒毛膜双胎定义为其中一个胎儿的估计体重低于第10百分位数，且估计胎儿体重差异>25%。记录首次给予倍他米松前（D0）、给药后24小时（D1）和48小时（D2）的脐动脉多普勒情况。将单绒毛膜双胎的胎盘沿血管赤道切成两个区域，获得估计的单个胎盘重量；胎盘份额不一致程度计算为[（适于胎龄胎儿的估计单个胎盘重量-生长受限胎儿的估计单个胎盘重量）/适于胎龄胎儿的估计单个胎盘重量]×100%。纳入的26例病例中有6例（23.1%）实现了倍他米松诱导的脐动脉舒张末期血流信号恢复。脐动脉舒张末期血流信号恢复组与未恢复组双胎之间，胎盘份额不一致程度和出生体重差异无显著差异。因此，根据我们的研究结果，虽然单绒毛膜双胎中IUGR胎儿的胎盘份额不一致程度与脐动脉多普勒异常相关，但倍他米松诱导的脐动脉舒张末期血流信号恢复与胎盘份额不一致程度的严重程度未显示出类似关系。
