不同产前管理策略对伴有脐动脉多普勒异常血流速度波形的单绒毛膜性双胎妊娠选择性宫内生长受限的短期和长期结局的影响：一项回顾性观察研究 108 例。

Impact of different prenatal management strategies in short- and long-term outcomes in monochorionic twin pregnancies with selective intrauterine growth restriction and abnormal flow velocity waveforms in the umbilical artery Doppler: a retrospective observational study of 108 cases.

机构信息

Obstetrics and Fetal Medicine, Hôpital Necker Enfants Malades, AP-HP, Paris, France.

EA7328 and PACT, Université Paris Descartes, Paris, France.

出版信息

BJOG. 2021 Jan;128(2):401-409. doi: 10.1111/1471-0528.16318. Epub 2020 Jun 8.

OBJECTIVES

To review perinatal and neurodevelopmental outcome (NDO) following selective fetoscopic laser coagulation (SFLC), cord coagulation (CC) or expectant management of monochorionic diamniotic twin pregnancies complicated with selective intrauterine growth restriction (sIUGR) and absent or reverse end-diastolic flow (AREDF) in the umbilical arteries (UA).

DESIGN AND SETTING

Single-centre retrospective observational study.

POPULATION

108 cases of sIUGR diagnosed before 26 weeks' gestation with AREDF in the UA.

METHODS

Survival rate and potential risk factors were analysed. NDO was assessed using parental questionnaires.

MAIN OUTCOMES MEASURES

Survival, gestational age at delivery and NDO.

RESULTS

SFLC, CC and EM were performed in 13, 50 and 45 cases, respectively, with an overall survival of 23.1, 40 and 77.8% and intrauterine demise of the co-twin of 30.8, 10 and 6.7% respectively. Intrauterine demise of the sIUGR twin occurred in 76.9 and 17.8% following SFLC and EM, respectively. The discordance in EFW at diagnosis was higher and absent/negative a-wave in the ductus venosus (DV) was more prevalent in the surgical groups. NDO in survivors at follow up was abnormal in 0 and 18% in the smaller twin following SFLC and EM, respectively, and in 25, 24 and 21% in the larger twin following SFLC, CC and EM, respectively.

CONCLUSION

SFLC yielded a poor result. EM seems a valid option when EFW discordance is <30% and a-wave in DV is positive. Otherwise, CC should be considered to protect the AGA co-twin. The long-term outcome of both small and large twins seems unaffected by the choice in primary prenatal management strategy.

TWEETABLE ABSTRACT

In type II sIUGR in MC twins, long-term neurodevelopment is normal in over 80% of the survivors.

目的

回顾选择性胎儿镜激光凝固术（SFLC）、脐带凝固术（CC）或期待治疗对伴有选择性宫内生长受限（sIUGR）和脐动脉（UA）无舒张末期血流（AREDF）或反向舒张末期血流（AREDF）的单绒毛膜双羊膜囊双胎的围产儿和神经发育结局（NDO）。

设计和设置

单中心回顾性观察性研究。

人群

108 例诊断为 sIUGR 的病例，在 26 周前 UA 出现 AREDF。

方法

分析生存率和潜在危险因素。NDO 通过父母问卷调查进行评估。

主要观察指标

生存率、分娩时的胎龄和 NDO。

结果

分别对 13、50 和 45 例患者进行了 SFLC、CC 和 EM 治疗，总生存率分别为 23.1%、40%和 77.8%，双胎宫内死亡的分别为 30.8%、10%和 6.7%。SFLC 和 EM 治疗后，sIUGR 胎儿的宫内死亡分别为 76.9%和 17.8%。在手术组中，诊断时 EFW 差异较大，且静脉导管（DV）中无/负 a 波更为常见。在随访中存活的患儿中，SFLC 和 EM 治疗后小胎儿的 NDO 异常分别为 0%和 18%，SFLC、CC 和 EM 治疗后大胎儿的 NDO 异常分别为 25%、24%和 21%。

结论

SFLC 效果不佳。当 EFW 差异<30%且 DV 中 a 波为阳性时，EM 似乎是一种有效的选择。否则，应考虑 CC 以保护 AGA 对胎。小胎儿和大胎儿的长期结局似乎不受产前管理策略的影响。

推特摘要

在 II 型 sIUGR 中，80%以上的幸存者神经发育正常。