Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA.
Am J Obstet Gynecol. 2013 May;208(5):393.e1-5. doi: 10.1016/j.ajog.2013.01.044. Epub 2013 Jan 28.
We sought to determine the perinatal risks associated with growth discordance in appropriately grown twin gestations.
We conducted a retrospective cohort study of all twin gestations excluding those complicated by monoamnionicity, twin-twin transfusion syndrome, structural anomalies, selective reduction, or a birthweight <10th percentile. Growth discordance was defined as ≥20%. Outcomes considered were stillbirth, preterm delivery <34 weeks and <28 weeks, and admission to the neonatal intensive care unit. Analyses were stratified by chorionicity.
Of 895 included dichorionic pregnancies, 63 (7.0%) were discordant. Discordant dichorionic twins were not at increased risk of preterm delivery <34 weeks (34.9% vs 25.6%; relative risk [RR], 1.4; 95% confidence interval [CI], 1.0-1.9), preterm delivery <28 weeks (3.2% vs 2.8%; RR, 1.1; 95% CI, 0.3-4.8), or admission to intensive care (26.9% vs 23.5%; RR, 1.5; 95% CI, 1.0-2.3). We had >90% power to detect a 2.5-fold increase in preterm delivery and admission to the neonatal intensive care unit in dichorionic twins. Of 250 monochorionic pregnancies, 23 (9.2%) were discordant. Monochorionic twin pregnancies were at increased risk of preterm delivery <34 weeks (65.2% vs 26.4%; RR, 2.5; 95% CI, 1.7-3.6), preterm delivery <28 weeks (34.8% vs 4.0%; RR, 8.8; 95% CI, 3.7-20.5), and admission to intensive care (68.2% vs 23.3%; RR, 2.9; 95% CI, 2.0-4.3).
In appropriately grown twins, growth discordance is a risk factor for adverse perinatal outcomes in monochorionic, but not dichorionic, twins. Discordant monochorionic twins may benefit from increased antenatal surveillance.
我们旨在确定与适当生长的双胎妊娠中生长不一致相关的围产期风险。
我们对所有双胎妊娠进行了回顾性队列研究，排除了单羊膜性、双胎输血综合征、结构异常、选择性减少或出生体重<第 10 百分位的病例。生长不一致定义为≥20%。考虑的结局包括死胎、早产<34 周和<28 周，以及新生儿重症监护病房入院。分析按绒毛膜性分层。
在 895 例纳入的双绒毛膜妊娠中，有 63 例（7.0%）存在不一致。不一致的双绒毛膜双胞胎早产<34 周的风险没有增加（34.9%比 25.6%；相对风险[RR]，1.4；95%置信区间[CI]，1.0-1.9），早产<28 周（3.2%比 2.8%；RR，1.1；95% CI，0.3-4.8），或入住重症监护病房（26.9%比 23.5%；RR，1.5；95% CI，1.0-2.3）。我们有超过 90%的效能来检测双绒毛膜双胞胎中早产和入住新生儿重症监护病房的风险增加 2.5 倍。在 250 例单绒毛膜妊娠中，有 23 例（9.2%）存在不一致。单绒毛膜双胞胎妊娠早产<34 周的风险增加（65.2%比 26.4%；RR，2.5；95% CI，1.7-3.6），早产<28 周（34.8%比 4.0%；RR，8.8；95% CI，3.7-20.5），以及入住重症监护病房（68.2%比 23.3%；RR，2.9；95% CI，2.0-4.3）。
在适当生长的双胞胎中，生长不一致是单绒毛膜双胞胎而非双绒毛膜双胞胎不良围产期结局的危险因素。不一致的单绒毛膜双胞胎可能受益于增加的产前监测。
