头臀长差异在早孕期：双胎妊娠不良结局的预测指标？
Crown-rump length discordance in the first trimester: a predictor of adverse outcome in twin pregnancies?
机构信息
Center for Fetal Medicine, Department of Obstetrics and Gynecology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
出版信息
Ultrasound Obstet Gynecol. 2014 Mar;43(3):277-83. doi: 10.1002/uog.12534. Epub 2014 Feb 12.
OBJECTIVES
To evaluate the usefulness of first-trimester crown-rump length (CRL) discordance in predicting adverse outcome in twin pregnancies.
METHODS
This retrospective study included a large cohort retrieved from local ultrasound databases at 14 obstetric departments in Denmark, comprising all twin pregnancies with two live fetuses scanned between 11 and 14 weeks' gestation during the period 1 January 2004 to 31 December 2006. The association between CRL discordance ≥ 10 % and adverse outcome was evaluated.
RESULTS
Among 1993 twin pregnancies, 1733 were dichorionic (156 (9%) discordant; 1577 (91%) concordant) and 260 were monochorionic (32 (12%) discordant; 228 (88%) concordant). In dichorionic twin pregnancies we found an association between CRL discordance ≥ 10% and preterm delivery before 34 weeks' gestation (P=0.007), birth weight discordance (P=0.001) and mean birth weight (P=0.033). In monochorionic twin pregnancies we found an association between CRL discordance ≥ 10% and birth weight discordance (P=0.02) and mean birth weight (P=0.03). To evaluate CRL discordance as a predictor of fetal loss and preterm delivery before 34 weeks' gestation, receiver-operating characteristics curves were created for each outcome. For CRL discordance ≥ 10% as a predictor of fetal loss and preterm delivery in dichorionic twin pregnancies, sensitivity was 0.17 (95% CI, 0.06-0.28) and 0.14 (95% CI, 0.10-0.18), respectively, and in monochorionic twin pregnancies it was 0.10 (95% CI, 0.03-0.22) and 0.16 (95% CI, 0.06-0.26), respectively.
CONCLUSIONS
CRL discordance in twin pregnancies is associated with, but is not a strong predictor of, adverse outcome.
目的
评估早孕期头臀长（CRL）差异在预测双胎妊娠不良结局中的作用。
方法
本回顾性研究纳入了丹麦 14 个产科部门的本地超声数据库中的一个大队列，包括 2004 年 1 月 1 日至 2006 年 12 月 31 日期间 11 至 14 周龄时扫描的所有具有两个活胎的双胎妊娠。评估 CRL 差异≥10%与不良结局之间的关系。
结果
在 1993 例双胎妊娠中，1733 例为双绒毛膜（156 例（9%）存在差异；1577 例（91%）存在一致性），260 例为单绒毛膜（32 例（12%）存在差异；228 例（88%）存在一致性）。在双绒毛膜双胎妊娠中，我们发现 CRL 差异≥10%与 34 周前早产（P=0.007）、出生体重差异（P=0.001）和平均出生体重（P=0.033）之间存在关联。在单绒毛膜双胎妊娠中，我们发现 CRL 差异≥10%与出生体重差异（P=0.02）和平均出生体重（P=0.03）之间存在关联。为了评估 CRL 差异作为胎儿丢失和 34 周前早产的预测因子，我们为每个结局绘制了接收器工作特征曲线。对于 CRL 差异≥10%作为双绒毛膜双胎妊娠中胎儿丢失和 34 周前早产的预测因子，其灵敏度分别为 0.17（95%CI，0.06-0.28）和 0.14（95%CI，0.10-0.18），而在单绒毛膜双胎妊娠中，其灵敏度分别为 0.10（95%CI，0.03-0.22）和 0.16（95%CI，0.06-0.26）。
结论
双胎妊娠的 CRL 差异与不良结局相关，但不是不良结局的强预测因子。
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