University of Texas Southwestern Medical Center, Department of Obstetrics and Gynecology, Dallas, Texas 75235-9032, USA.
Obstet Gynecol. 2012 Oct;120(4):759-65. doi: 10.1097/AOG.0b013e318269be76.
To estimate the effect of hydramnios on pregnancy outcomes in dichorionic and monochorionic twins.
This is a retrospective cohort study of women with twin pregnancies who underwent ultrasound evaluation between 1997 and 2010 and delivered liveborn neonates or stillborn fetuses at 24 weeks of gestation or more at a single institution. Hydramnios was defined as a single deepest pocket of amniotic fluid of at least 8 cm, and it was further categorized as mild (8-9.9 cm), moderate (10-11.9 cm), or severe (12 cm or more). The greatest degree of hydramnios identified during pregnancy was used for analysis. Monoamniotic pregnancies and pregnancies complicated by twin-twin transfusion syndrome were excluded. Anomalous neonates and stillborn fetuses were analyzed separately.
Of 1,951 twin pregnancies, 1,311 were dichorionic (67%) and 640 were monochorionic (33%). Hydramnios was identified in 348 pregnancies (18%). Major anomalies were more common with increasing hydramnios in both dichorionic and monochorionic twins (P<.001), with anomaly prevalence nearly 20% in cases of severe hydramnios. Severe hydramnios was significantly associated with stillbirth in monochorionic gestations (3 of 11, 27%, P<.001). Hydramnios was not associated with preterm delivery, fetal growth restriction, neonatal intensive care unit admission, or neonatal death in either dichorionic or monochrorionic pregnancies.
Hydramnios is common in twins, occurring in one of six dichorionic and monochorionic pregnancies. Anomaly prevalence increased with degree of hydramnios; in monochorionic gestations, severe hydramnios was associated with risk of stillbirth. Despite this, adverse outcomes do not appear to be more frequent in the setting of hydramnios in twin getstaions.
II.
评估羊水过多对双绒毛膜和单绒毛膜双胞胎妊娠结局的影响。
这是一项回顾性队列研究，纳入了 1997 年至 2010 年间在一家机构接受超声评估且分娩孕周为 24 周及以上的活产新生儿或死胎的双胎妊娠女性。羊水过多定义为羊水最大深度至少为 8cm，进一步分为轻度（8-9.9cm）、中度（10-11.9cm）或重度（12cm 或以上）。分析时采用妊娠期间羊水过多的最大程度。排除单羊膜囊妊娠和伴有双胎输血综合征的妊娠。单独分析异常新生儿和死胎。
在 1951 例双胎妊娠中，1311 例为双绒毛膜（67%），640 例为单绒毛膜（33%）。348 例（18%）存在羊水过多。在双绒毛膜和单绒毛膜双胞胎中，随着羊水过多程度的增加，主要异常更为常见（P<.001），重度羊水过多的异常发生率接近 20%。重度羊水过多与单绒毛膜妊娠的死胎显著相关（11 例中 3 例，27%，P<.001）。在双绒毛膜或单绒毛膜妊娠中，羊水过多与早产、胎儿生长受限、新生儿重症监护病房入院或新生儿死亡均无关。
羊水过多在双胎妊娠中很常见，占双绒毛膜和单绒毛膜妊娠的六分之一。异常发生率随羊水过多程度增加而增加；在单绒毛膜妊娠中，重度羊水过多与死胎风险相关。尽管如此，在双胎妊娠中羊水过多的情况下，不良结局似乎并不更为常见。
II 级。
