Fetal Medicine Unit, St George's University of London, London, UK.
Fetal Medicine Unit, St George's University of London, London, UK.
Semin Fetal Neonatal Med. 2018 Apr;23(2):133-141. doi: 10.1016/j.siny.2017.11.008. Epub 2018 Feb 18.
In the decades since the introduction of ultrasound into routine obstetric practice, the advantages of ultrasound have moved beyond the simple ability to identify multiple pregnancies antenatally to the possibility of screening them for fetal anomalies, pre-eclampsia, preterm birth, and the complications specific to monochorionic pregnancies. Screening studies have often excluded twins because physiological differences impact on the validity and sensitivity of the screening tests in routine use in singletons, and therefore, the evidence of screening performance in multiple pregnancy lags behind the evidence from singleton pregnancies. In general, most pregnancy complications are more common in twin pregnancy, but screening tests are less accurate or well validated. In this review article we present the current state of the evidence and avenues for future research relating to the use of ultrasound and screening for complications in twin pregnancies, including the monochorionicity-related pathologies, such as twin-twin transfusion syndrome, selective growth restriction, twin anaemia-polycythaemia sequence and twin reversed arterial perfusion sequence.
自超声技术引入常规产科实践以来的几十年里，超声的优势已经超越了单纯识别多胎妊娠的能力，发展到了筛查胎儿异常、子痫前期、早产以及单绒毛膜性妊娠特有并发症的可能性。筛查研究往往排除了双胞胎，因为生理差异会影响在单胎中常规使用的筛查试验的有效性和敏感性，因此，多胎妊娠的筛查性能证据落后于单胎妊娠的证据。一般来说，大多数妊娠并发症在双胞胎妊娠中更为常见，但筛查试验的准确性或验证程度较差。在这篇综述文章中，我们介绍了目前关于超声在双胞胎妊娠中的应用以及用于筛查并发症的证据现状和未来研究方向，包括与单绒毛膜性相关的病理，如双胎输血综合征、选择性生长受限、双胎贫血-红细胞增多序列和双胎反向动脉灌注序列。
