早孕期超声预测单绒毛膜双羊膜囊双胎的产科及新生儿结局。

First-trimester sonographic prediction of obstetric and neonatal outcomes in monochorionic diamniotic twin pregnancies.

机构信息

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.

出版信息

J Ultrasound Med. 2014 Jan;33(1):135-40. doi: 10.7863/ultra.33.1.135.

DOI:10.7863/ultra.33.1.135

PMID:24371108

Abstract

OBJECTIVES

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

摘要

目的

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。

方法

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。

结果

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）。