单绒毛膜双胎妊娠合并胎盘功能不全时的胎儿静脉循环：预测出生时酸血症或宫内胎儿死亡。

Fetal venous circulation in monochorionic twin pregnancies with placental insufficiency: prediction of acidemia at birth or intrauterine fetal death.

作者信息

Liao T B, Nomura R M Y, Liao A W, Francisco R P V, Zugaib M

机构信息

Department of Obstetrics and Gynecology, School of Medicine, University of São Paulo, São Paulo, Brazil.

出版信息

Ultrasound Obstet Gynecol. 2014 Apr;43(4):426-31. doi: 10.1002/uog.12549. Epub 2014 Mar 12.

DOI:10.1002/uog.12549

PMID:23828752

Abstract

OBJECTIVES

To investigate fetal venous Doppler measurements in monochorionic twin pregnancies complicated by placental insufficiency and the relationship between fetal venous flow and acidemia at birth or intrauterine fetal death.

METHODS

This was a prospective study of 18 monochorionic twin pregnancies with placental insufficiency. Inclusion criteria were monochorionic-diamniotic twin pregnancy, abnormal umbilical artery (UA) Doppler indices, intact membranes and absence of fetal congenital abnormalities. Cases of twin-to-twin transfusion syndrome were excluded. The following Doppler measurements were studied: UA pulsatility index (PI), ductus venosus PI, middle cerebral artery PI and peak systolic velocity, intra-abdominal umbilical vein (UV) time-averaged maximum velocity (TAMXV) and left portal vein (LPV) TAMXV. Doppler parameters were transformed into Z-scores (SD values from the mean) or multiples of the median according to normative references.

RESULTS

UA pH < 7.20 occurred in nine (25.0%) neonates, pH < 7.15 in four (11.1%) and intrauterine death in four (11.1%) fetuses. The UV-TAMXV and LPV-TAMXV Z-scores were significantly lower in the group with pH < 7.20 or intrauterine fetal death (-1.79 vs -1.22, P = 0.006 and -2.26 vs -1.13, P = 0.04, respectively). In cases with pH < 7.15 or intrauterine fetal death, UV pulsations were more frequent (50.0% vs 10.7%, P = 0.03) and UV-TAMXV Z-score was significantly lower (-1.89 vs -1.26, P = 0.003). Mixed effects logistic regression analysis, accounting for the paired nature of the outcomes for the two twins in each pregnancy, demonstrated that the UV-TAMXV Z-score significantly predicted UA pH at birth < 7.20 or intrauterine fetal death. The Doppler parameter that independently predicted pH < 7.15 or intrauterine fetal death was presence of pulsation in the UV.

CONCLUSION

UV Doppler parameters may predict acidemia at birth or intrauterine fetal death in monochorionic twins complicated by placental insufficiency.

摘要

目的

研究单绒毛膜双胎妊娠合并胎盘功能不全时的胎儿静脉多普勒测量值，以及胎儿静脉血流与出生时酸血症或宫内胎儿死亡之间的关系。

方法

这是一项对18例单绒毛膜双胎妊娠合并胎盘功能不全的前瞻性研究。纳入标准为单绒毛膜双羊膜囊双胎妊娠、脐动脉（UA）多普勒指数异常、胎膜完整且无胎儿先天性异常。双胎输血综合征病例被排除。研究了以下多普勒测量值：UA搏动指数（PI）、静脉导管PI、大脑中动脉PI和收缩期峰值速度、腹内脐静脉（UV）时间平均最大速度（TAMXV）和左门静脉（LPV）TAMXV。根据标准参考值，将多普勒参数转换为Z分数（相对于均值的标准差）或中位数倍数。

结果

9例（25.0%）新生儿出生时UA pH < 7.20，4例（11.1%）pH < 7.15，4例（11.1%）胎儿宫内死亡。在pH < 7.20或宫内胎儿死亡的组中，UV-TAMXV和LPV-TAMXV Z分数显著更低（分别为-1.79对-1.22，P = 0.006；-2.26对-1.13，P = 0.04）。在pH < 7.15或宫内胎儿死亡的病例中，UV搏动更频繁（50.0%对10.7%，P = 0.03），且UV-TAMXV Z分数显著更低（-1.89对-1.26，P = 0.003）。考虑到每次妊娠中两个胎儿结局的配对性质，进行的混合效应逻辑回归分析表明，UV-TAMXV Z分数显著预测出生时UA pH < 7.20或宫内胎儿死亡。独立预测pH < 7.15或宫内胎儿死亡的多普勒参数是UV搏动的存在。