多普勒检查能否加强对无并发症的单绒毛膜双羊膜囊双胎的监测？

Do Doppler studies enhance surveillance of uncomplicated monochorionic diamniotic twins?

作者信息

Pessel Cara, Merriam Audrey, Vani Kavita, Brubaker Sara G, Zork Noelia, Zhang Yuan, Simpson Lynn L, Gyamfi-Bannerman Cynthia, Miller Russell

机构信息

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York USA (C.P., S.G.B., N.Z., L.L.S., C.G.-B., R.M.); Department of Obstetrics and Gynecology, Christiana Care Health System, Wilmington, Delaware USA (A.M.); Columbia University College of Physicians and Surgeons, New York, New York USA (K.V.); and Department of Biostatistics, Joseph L. Mailman School of Public Health, Columbia University, New York, New York USA (Y.Z.).

出版信息

J Ultrasound Med. 2015 Apr;34(4):569-75. doi: 10.7863/ultra.34.4.569.

DOI:10.7863/ultra.34.4.569

PMID:25792571

Abstract

OBJECTIVES

To determine whether isolated abnormal Doppler indices before 28 weeks predict adverse pregnancy outcomes in uncomplicated monochorionic diamniotic (MCDA) twins.

METHODS

A retrospective cohort study of MCDA twin pregnancies receiving antenatal testing at a single center between 2007 and 2013 was conducted. Sonographic surveillance, including Doppler velocimetric studies of the umbilical artery, ductus venosus, and middle cerebral artery of each twin, was initiated by 28 weeks and repeated at least every 2 weeks. All pregnancies were deemed "uncomplicated" at initial sonography, without evidence of polyhydramnios, oligohydramnios, intrauterine growth restriction, twin growth discordance of at least 20%, structural or chromosomal anomalies, or unclear chorionicity. Pregnancies were divided into 2 groups: those with isolated Doppler abnormalities before 28 weeks and those with normal Doppler indices. The primary outcome was a composite including twin-twin transfusion syndrome, intrauterine growth restriction of more than 1 twin, growth discordance of at least 20%, preterm delivery before 34 weeks for fetal indications, or demise of more than 1 fetus.

RESULTS

Ninety-six patients were included, with 22 (22.9%) having isolated Doppler abnormalities before 28 weeks. The incidence of the primary outcome did not differ between groups (36.4% versus 28.4%; P = .47). The abnormal Doppler group underwent a greater number of sonographic examinations (15 versus 10; P= .001) and more antenatal admissions for fetal concerns (50.0% versus 12.2%; P < .001).

CONCLUSIONS

Isolated Doppler abnormalities are commonly encountered in uncomplicated MCDA pregnancies before 28 weeks yet are not clearly predictive of twin-specific complications. Doppler abnormalities were associated with increased sonographic surveillance and antenatal hospitalizations, suggesting an influence on physician practice patterns. Data may not support Doppler studies before 28 weeks for routine MCDA twin monitoring.

摘要

目的

确定孕28周前孤立的异常多普勒指标是否可预测无并发症的单绒毛膜双羊膜囊（MCDA）双胎妊娠的不良妊娠结局。

方法

对2007年至2013年间在单一中心接受产前检查的MCDA双胎妊娠进行回顾性队列研究。超声监测，包括对每个胎儿的脐动脉、静脉导管和大脑中动脉进行多普勒血流速度研究，在孕28周前开始，至少每2周重复一次。所有妊娠在初次超声检查时均被视为“无并发症”，无羊水过多、羊水过少、胎儿生长受限、双胎生长不一致至少20%、结构或染色体异常或绒毛膜性不明的证据。妊娠分为两组：孕28周前有孤立多普勒异常的和多普勒指标正常的。主要结局是一个综合指标，包括双胎输血综合征、超过1个胎儿的胎儿生长受限、至少20%的生长不一致、因胎儿指征在34周前早产或超过1个胎儿死亡。