Algeri Paola, Frigerio Matteo, Lamanna Maria, Petrova Petya Vitanova, Cozzolino Sabrina, Incerti Maddalena, Mastrolia Salvatore Andrea, Roncaglia Nadia, Vergani Patrizia
Department of Obstetrics and Gynecology, University of Milano-Bicocca, Fondazione MBBM, San Gerardo Hospital, Monza, Italy.
J Perinat Med. 2018 Nov 27;46(9):1028-1034. doi: 10.1515/jpm-2017-0253.
The aim of the present study was to assess, in a population of dichorionic twin pregnancies with selective growth restriction, the effect of inter-twin differences by use of Doppler velocimetry and fetal growth discordancy on perinatal outcomes.
This was a retrospective study including dichorionic twin pregnancies from January 2008 to December 2015 at the Department of Obstetrics and Gynecology of Fondazione MBBM. Only dichorionic twin pregnancies affected by selective intrauterine growth restriction (IUGR) delivering at ≥24 weeks were included in the study.
We found that twin pregnancies with inter-twin estimated fetal weight (EFW) discordance ≥15% were significantly associated with a higher risk of preterm delivery before 32 (P=0.004) and 34 weeks (P=0.04). Similarly, twin pregnancies with inter-twin abdominal circumference (AC) discordance ≥30° centiles were associated with a higher rate of neonatal intensive care unit (NICU) admission (P=0.02), neonatal resuscitation (P=0.02) and adverse neonatal composite outcome (P=0.04). Of interest, when comparing twin pregnancies according to Doppler study, growth restricted twins had a higher rate of composite neonatal outcome and in multivariate analysis, an abnormal Doppler was an independent risk factor for this outcome.
Our study associated growth discrepancy with specific pregnancy outcomes, according to defined cut-offs. In addition, we demonstrated that an abnormal umbilical artery Doppler is independently associated with a composite neonatal adverse outcome in growth restricted fetuses.
本研究旨在评估在双绒毛膜双胎妊娠且存在选择性生长受限的人群中，利用多普勒测速法测量的双胎差异以及胎儿生长不一致对围产期结局的影响。
这是一项回顾性研究，纳入了2008年1月至2015年12月在Fondazione MBBM妇产科的双绒毛膜双胎妊娠病例。本研究仅纳入孕龄≥24周且受选择性宫内生长受限（IUGR）影响的双绒毛膜双胎妊娠。
我们发现，双胎间估计胎儿体重（EFW）差异≥15%的双胎妊娠与32周（P=0.004）和34周（P=0.04）前早产的较高风险显著相关。同样，双胎间腹围（AC）差异≥30百分位数的双胎妊娠与新生儿重症监护病房（NICU）入住率较高（P=0.02）、新生儿复苏（P=0.02）及不良新生儿综合结局（P=0.04）相关。有趣的是，根据多普勒研究比较双胎妊娠时，生长受限的双胎有更高的新生儿综合结局发生率，且在多变量分析中，异常多普勒是该结局的独立危险因素。
我们的研究根据设定的临界值，将生长差异与特定的妊娠结局相关联。此外，我们证明脐动脉多普勒异常与生长受限胎儿的新生儿不良综合结局独立相关。
