无心畸形儿双胎的形态学、胎儿内血管模式和脐动脉多普勒指数。

Morphology, intrafetal vascular pattern, and umbilical artery Doppler indices of acardiac twins.

机构信息

Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Mahidol University, Bangkok, Thailand.

Division of Clinical Epidemiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

出版信息

Prenat Diagn. 2020 Jul;40(8):958-965. doi: 10.1002/pd.5710. Epub 2020 Apr 26.

DOI:10.1002/pd.5710

PMID:32297344

Abstract

BACKGROUND

Twin reversed arterial perfusion (TRAP) sequence consists of acardiac twin (A) paradoxically perfused by pump twin (P) through an umbilical artery (UA). We proposed characterization of acardiac twins with intrafetal vascular pattern (IVP), and assessed its correlation with morphology and UA Doppler indices.

METHODS

We prospectively evaluated 21 cases of TRAP sequence. Morphology (acardia vs hemicardia) and IVP (simple vs complex) of acardiac twins were characterized with ultrasound and color Doppler. Twins weight ratio (A/P Wt) and UA Doppler indices of acardiac and pump twins including (1) difference of systolic/diastolic ratio (UA ∆S/D), (2) difference of resistance index (UA ∆RI), and (3) ratio of pulsatility index (UA PI A/P) were calculated.

RESULTS

The median (min, max) gestational age at diagnosis was 18 (11, 27) weeks. Acardia (n = 14) were associated with simple IVP (n = 16) (P < .05). After exclusion of acardia with complex IVP (n = 1), the A/P Wt, UA ∆S/D, UA ∆RI, and UA PI A/P of acardia with simple IVP (n = 13), hemicardia with simple IVP (n = 3), and hemicardia with complex IVP (n = 4) were not significantly different (P > .05).

CONCLUSIONS

Most of acardiac twins were acardia with simple IVP. Morphology and IVP of acardiac twins were not associated with UA Doppler indices.

摘要

背景

双胎反向动脉灌注（TRAP）序列由泵血双胎（P）通过脐动脉（UA）反常地灌注无心双胎（A）组成。我们提出了用胎儿内血管模式（IVP）对无心双胎进行特征描述，并评估其与形态和 UA 多普勒指数的相关性。

方法

我们前瞻性评估了 21 例 TRAP 序列。通过超声和彩色多普勒评估无心双胎的形态（无心畸形与半心畸形）和 IVP（简单型与复杂型）。计算无心和泵血双胎的体重比（A/P Wt）和 UA 多普勒指数，包括（1）收缩期/舒张期比值差异（UA ∆S/D），（2）阻力指数差异（UA ∆RI），和（3）搏动指数比值（UA PI A/P）。

结果

诊断时的中位（最小，最大）胎龄为 18（11，27）周。无心畸形（n=14）与简单 IVP（n=16）相关（P<0.05）。排除 IVP 复杂的无心畸形（n=1）后，简单 IVP 的无心畸形（n=13）、简单 IVP 的半心畸形（n=3）和复杂 IVP 的半心畸形（n=4）的 A/P Wt、UA ∆S/D、UA ∆RI 和 UA PI A/P 无显著差异（P>0.05）。