Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Pavilion for Women-Texas Children's Fetal Center, 6651 Main St, Suite F1020, Houston, TX 77030 USA.
J Ultrasound Med. 2014 Jan;33(1):135-40. doi: 10.7863/ultra.33.1.135.
The purpose of this study was to investigate whether discordant nuchal translucency and crown-rump length measurements in monochorionic diamniotic twins are predictive of adverse obstetric and neonatal outcomes.
We conducted a multicenter retrospective cohort study including all monochorionic diamniotic twin pregnancies with two live fetuses at the 11-week to 13-week 6-day sonographic examination who had serial follow-up sonography until delivery. Isolated nuchal translucency, crown-rump length, and combined discordances were correlated with adverse obstetric outcomes, individually and in composite, including the occurrence of 1 or more of the following in either fetus: intrauterine growth restriction (IUGR), twin-twin transfusion syndrome (TTTS), intrauterine fetal death (IUFD), growth discordance (≥ 20%), and preterm birth before 28 weeks' gestation. Correlations with adverse composite neonatal outcomes were also studied. A receiver operating characteristic curve analysis and a logistic regression analysis with a generalized estimating equation were conducted.
Fifty-four of the 177 pregnancies included (31%) had an adverse composite obstetric outcome, with TTTS in 19 (11%), IUGR in 21 (12%), discordant growth in 14 (8%), IUFD in 14 (8%), and preterm birth before 28 weeks in 10 (6%). Of the 254 neonates included in the study, 69 (27%) were complicated by adverse composite neonatal outcomes, with respiratory distress syndrome being the most common (n = 59 [23%]). The areas under the curve for the combined discordances to predict composite obstetric and neonatal outcomes were 0.62 (95% confidence interval, 0.52-0.72), and 0.54 (95% confidence interval, 0.46-0.61), respectively.
In our population, nuchal translucency, crown-rump length, and combined discordances in monochorionic diamniotic twin pregnancies were not predictive of adverse composite obstetric and neonatal outcomes.
本研究旨在探讨单绒毛膜双羊膜囊双胎颈项透明层（nuchal translucency，NT）和头臀长（crown-rump length，CRL）测量值不一致是否与不良产科和新生儿结局相关。
我们进行了一项多中心回顾性队列研究，纳入了所有在 11 周至 13 周 6 天超声检查时具有两个存活胎儿的单绒毛膜双羊膜囊双胎妊娠，并对其进行了连续的超声随访直至分娩。孤立的 NT、CRL 以及两者联合的不一致与不良产科结局相关，包括以下任何一个胎儿发生 1 种或多种情况：胎儿生长受限（intrauterine growth restriction，IUGR）、双胎输血综合征（twin-twin transfusion syndrome，TTTS）、胎儿宫内死亡（intrauterine fetal death，IUFD）、生长不一致（≥20%）和 28 周前早产。同时也研究了与不良复合新生儿结局的相关性。采用受试者工作特征曲线分析和广义估计方程的逻辑回归分析。
在 177 例妊娠中，54 例（31%）发生了不良复合产科结局，其中 19 例（11%）发生 TTTS、21 例（12%）发生 IUGR、14 例（8%）发生生长不一致、14 例（8%）发生 IUFD、10 例（6%）发生 28 周前早产。在纳入的 254 例新生儿中，69 例（27%）存在不良复合新生儿结局，其中最常见的是呼吸窘迫综合征（n = 59[23%]）。联合不一致预测复合产科和新生儿结局的曲线下面积分别为 0.62（95%置信区间，0.52-0.72）和 0.54（95%置信区间，0.46-0.61）。
在我们的人群中，NT、CRL 和单绒毛膜双羊膜囊双胎妊娠的联合不一致不能预测不良复合产科和新生儿结局。
