Maternal Fetal Medicine Unit, Department of Woman and Child Health, University of Padua, Padua, Italy.
J Perinat Med. 2013 May;41(3):309-16. doi: 10.1515/jpm-2012-0133.
To assess perinatal outcome in type II monochorionic (MC) diamniotic twin pregnancies (DA) affected by selective intrauterine growth restriction (sIUGR) and abnormal cord insertion managed expectantly.
A prospective longitudinal study from June 2008 and July 2011 on 24 MCDA sIUGR twins. sIUGR was defined as estimated fetal weight below the 10th percentile in one twin and was classified into three groups based on umbilical artery (UA) Doppler diastolic flow (I: presence; II: constantly absent/reverse (AEDF/ARED); III: intermittently absent or reverse). Marginal cord insertion was defined as insertion within 2 cm of the placental disc edge, and velamentous insertion as a cord insertion into the fetal membranes. Expectant management was chosen in these twins, and absent or reverse A wave in the ductus venosus (DV) was a criterion for delivery. Neonatal outcome was available for all twins delivered. Pathological examination and vascular cast of placentas were performed in all cases.
Fourteen twin pregnancies were type II sIUGR, and ten presented an abnormal umbilical cord insertion. Median gestational age (GA) at diagnosis of sIUGR was 18 weeks' gestation (range 16-20 weeks), and all sIUGR co-twins showed AEDF of UA at a median gestational age of 20 weeks (range 18-22 weeks). Median gestational age at delivery was 30 weeks (range 28-34 weeks) with a median birth weight of 1285 g (range 307-1725 g). pH at birth and base excess (BE) were normal in all IUGR co-twin (pH>7.10, median BE 5.5); Apgar score at 5 min was >7. Perinatal outcome was favorable in all cases. Placental pathological examination confirmed the marginal insertion of the umbilical cord and the absence of anastomosis between the two portions of umbilical insertion.
This study highlights that expectant management for sIUGR type II twins with or without an abnormal cord insertion should be a valid option to time delivery for these fetuses as shown by the favorable neonatal outcome.
评估受选择性宫内生长受限（sIUGR）和异常脐带插入影响的 II 型单绒毛膜（MC）双羊膜囊（DA）双胎妊娠的围产结局，并对其进行期待治疗。
这是一项从 2008 年 6 月至 2011 年 7 月进行的前瞻性纵向研究，纳入了 24 例 sIUGR 双胎妊娠的 MC-DA 双胎。sIUGR 定义为一个胎儿的估计胎儿体重低于第 10 百分位数，并根据脐动脉（UA）多普勒舒张期血流（I：存在；II：持续缺失/反向（AEDF/ARED）；III：间歇性缺失或反向）将其分为三组。边缘性脐带插入定义为插入胎盘边缘 2 cm 内，帆状插入定义为脐带插入胎膜。这些双胞胎选择期待治疗，而静脉导管（DV）中出现缺失或反向 A 波则是分娩的标准。所有分娩的双胞胎均获得了新生儿结局。对所有病例均进行了胎盘的病理检查和血管铸型。
14 例妊娠为 II 型 sIUGR，10 例存在异常脐带插入。sIUGR 的中位诊断孕周为 18 周（范围 16-20 周），所有 sIUGR 双胎在中位孕周 20 周（范围 18-22 周）时均出现 UA 的 AEDF。分娩的中位孕周为 30 周（范围 28-34 周），中位出生体重为 1285g（范围 307-1725g）。所有 IUGR 双胎的出生时 pH 和碱剩余（BE）均正常（pH>7.10，中位 BE 为 5.5）；5 分钟时的 Apgar 评分为>7。所有病例的围产结局均良好。胎盘病理检查证实脐带边缘插入，且两个脐带插入部分之间无吻合。
本研究强调，对于有或没有异常脐带插入的 II 型 sIUGR 双胎妊娠，期待治疗应是一种有效的选择，可以根据良好的新生儿结局来确定胎儿的分娩时机。
