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单绒毛膜双胎与双绒毛膜双胎:卡内特试验与出生后神经发育

Monochorionic vs Dichorionic Twins: Kanet Test vs Postnatal Neurodevelopment.

作者信息

Bot Mihaela, Vladareanu Radu, Burnei Anca, Munteanu Alexandra, Calo Ioana, Vladareanu Simona

机构信息

Department of Obstetrics-Gynecology and Neonatology, Elias Emergency Hospital Bucharest, Bucharest, Romania.

University of Medicine and Pharmacy Carol Davila, Bucharest, Romania.

出版信息

Maedica (Bucur). 2020 Mar;15(1):61-70. doi: 10.26574/maedica.2020.15.1.61.

Abstract

The twin pregnancy is a risk pregnancy, being associated with a series of fetal and neonatal complications when compared to singleton pregnancies. Ultrasound assessment of the fetal brain is mandatory in the prenatal screening for fetal, congenital and acquired anomalies. Fetal neurosonography is useful in the prenatal diagnosis of cerebral anomalies, combining ultrasonography with fetal ultrasound. In this study, we assessed the Kanet score in two populations of pregnant women with dichorionic twin pregnancies (DC twin) (n=67) and monochorionic twin pregnancies (MC twin) (n=24). In the two groups we included pregnancies with normal fetal growth and pregnancies with discordant fetal growth (DC twin) and selective intrauterine reatriction (MC twin). For both groups, we assessed the antenatal Kanet score during three visits and compared the results with the neurodevelopment immediately after birth up to the two-year-old children. The calculation of the average values of the Kanet score for dichorionic pregnancies revealed normal, maximal average values at all three visits, for all fetuses, no matter if they had normal growth or discordant growth. At the first and third visit, we observed statistically significant differences between the average Kanet scores in DC twins with discordant growth DC twins with normal growth. The analysis of average values of the Kanet score in the group of MC twin pregnancies revealed statistically significant differences between monochorionic twins with discordant growth twins with normal growth at all three visits (p=0.0001), with average values between 17.30 and 19.62 being deemed normal. Amiel-Tison score was used as a standard tool for the neurological assessment both immediately after birth and for children up to two years of age.

摘要

双胎妊娠是一种高危妊娠,与单胎妊娠相比,会伴有一系列胎儿和新生儿并发症。在产前筛查胎儿先天性和后天性异常时,对胎儿脑部进行超声评估是必不可少的。胎儿神经超声检查结合了超声成像和胎儿超声检查,对脑部异常的产前诊断很有用。在本研究中,我们评估了两组双绒毛膜双胎妊娠(DC双胎,n = 67)和单绒毛膜双胎妊娠(MC双胎,n = 24)孕妇的卡内特评分。在这两组中,我们纳入了胎儿生长正常的妊娠以及胎儿生长不一致(DC双胎)和选择性宫内生长受限(MC双胎)的妊娠。对于这两组,我们在三次就诊时评估了产前卡内特评分,并将结果与出生后直至两岁儿童的神经发育情况进行了比较。双绒毛膜妊娠卡内特评分平均值的计算显示,在所有三次就诊时,所有胎儿的平均值均正常且为最大值,无论其生长正常与否。在第一次和第三次就诊时,我们观察到生长不一致的DC双胎与生长正常的DC双胎之间的平均卡内特评分存在统计学显著差异。对MC双胎妊娠组卡内特评分平均值的分析显示,在所有三次就诊时,生长不一致的单绒毛膜双胎与生长正常的双胎之间存在统计学显著差异(p = 0.0001),平均值在17.30至19.62之间被视为正常。阿米尔 - 蒂森评分被用作出生后及两岁以下儿童神经学评估的标准工具。

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