Francisco C, Wright D, Benkő Z, Syngelaki A, Nicolaides K H
Fetal Medicine Research Institute, Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
Institute of Health Research, University of Exeter, Exeter, UK.
Ultrasound Obstet Gynecol. 2017 Jul;50(1):88-92. doi: 10.1002/uog.17470.
To examine the gestational age at delivery in dichorionic (DC) and monochorionic (MC) twin pregnancies, with and without pre-eclampsia (PE), and to determine the relative risk of total and preterm PE compared with that in singleton pregnancies.
This was a screening study for PE in twin pregnancies undergoing first-trimester combined screening for aneuploidy and subsequently delivering two phenotypically normal live or stillborn babies at ≥ 24 weeks' gestation. The distribution of gestational age at delivery in DC and MC twins was determined and compared with that in singleton pregnancies from the same population. The relative risk for total and preterm PE in twins compared with singleton pregnancies was determined. Kaplan-Meier estimates of the cumulative incidence of PE in twin and singleton pregnancies, assuming no other cause for delivery, were determined and hazard ratios for twins relative to singletons were obtained from a Cox proportional hazards regression model.
The incidence of PE in singletons was 2.3% (2162/93 297), in DC twin pregnancies was 8.1% (145/1789) and in MC twin pregnancies was 6.0% (26/430). Compared with singletons, the relative risk of total PE was 3.5 for DC twins and 2.6 for MC twins. Delivery < 37 weeks' gestation occurred in 5.5% of singletons, 46.5% of DC twins and 91.4% of MC twins. The incidence of preterm PE was 0.6%, 5.5% and 5.8% for singletons, DC twins and MC twins, respectively. Compared with singletons, the relative risk of preterm PE was 8.7 for DC twins and 9.1 for MC twins. In the Cox proportional hazards regression model, the hazard ratios for DC and MC twin pregnancies relative to singleton pregnancies were 14 and 23, respectively.
The relative risk of preterm PE in DC and MC twins is similar and substantially higher than in singleton pregnancies. In ongoing twin pregnancies, the high relative risk of PE may merit a higher intensity of monitoring than is routine for singleton pregnancies. © 2017 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
研究双绒毛膜（DC）双胎妊娠和单绒毛膜（MC）双胎妊娠分娩时的孕周，以及有无子痫前期（PE）的情况，并确定双胎妊娠与单胎妊娠相比发生总体子痫前期和早发型子痫前期的相对风险。
这是一项针对双胎妊娠子痫前期的筛查研究，这些双胎妊娠在孕早期接受了非整倍体联合筛查，随后在孕24周及以上分娩出两个表型正常的活产或死产婴儿。确定并比较DC双胎和MC双胎分娩时孕周的分布情况，以及来自同一人群的单胎妊娠的孕周分布情况。确定双胎妊娠与单胎妊娠相比发生总体子痫前期和早发型子痫前期的相对风险。在假设无其他分娩原因的情况下，确定双胎妊娠和单胎妊娠子痫前期累积发病率的Kaplan-Meier估计值，并从Cox比例风险回归模型中获得双胎相对于单胎的风险比。
单胎妊娠子痫前期的发病率为2.3%（2162/93297），DC双胎妊娠为8.1%（145/1789），MC双胎妊娠为6.0%（26/430）。与单胎妊娠相比，DC双胎发生总体子痫前期的相对风险为3.5，MC双胎为2.6。单胎妊娠中孕周<37周分娩的发生率为5.5%，DC双胎为46.5%，MC双胎为91.4%。单胎、DC双胎和MC双胎早发型子痫前期的发病率分别为0.6%、5.5%和5.8%。与单胎妊娠相比，DC双胎发生早发型子痫前期的相对风险为8.7，MC双胎为9.1。在Cox比例风险回归模型中，DC双胎妊娠和MC双胎妊娠相对于单胎妊娠的风险比分别为14和23。
DC双胎和MC双胎发生早发型子痫前期的相对风险相似，且显著高于单胎妊娠。对于正在进行的双胎妊娠，子痫前期的高相对风险可能需要比单胎妊娠常规监测强度更高的监测。©2017作者。《妇产科超声》由John Wiley & Sons Ltd代表国际妇产科超声学会出版。
