Lee SiWon, Lee Hyun-Mi, Han You Jung, Kim Moon Young, Boo Hye Yeon, Chung Jin Hoon
Department of Obstetrics and Gynecology, Mount Sinai Medical Center, Miami Beach, FL 33109, USA.
Department of Obstetrics and Gynecology, CHA Ilsan Medical Center, CHA University, Goyang 10414, Korea.
J Clin Med. 2021 Jan 23;10(3):433. doi: 10.3390/jcm10030433.
To assess clinical implications of increased nuchal translucency (INT) in twin pregnancies based on the chorionicity. This was a retrospective review of the twin pregnancies who underwent first trimester ultrasound with nuchal translucency (NT) measurement at 11-13 weeks of gestation from January 2006 to December 2014. Data were collected using the OB database and the chart review. Pregnancy outcomes, including gestational weeks at the delivery, abnormal fetal karyotypes, fetal structural anomalies, and twin-specific complications, were analyzed. A total of 1622 twin pregnancies with INT ≥ 95th percentile in one or both fetuses were identified. In all twin pregnancies with INT, abnormal fetal karyotypes were identified in 17 (8.6%) patients (odds ratio = 13.28, CI = 5.990-29.447, = 0.000) and twin-specific complications were identified in 23 (11.6%) patients (odds ratio = 2.398, CI = 1.463-3.928, = 0.001) compared to those with normal NT. Among the INT group, when the groups were subdivided into monochorionic (MC) and dichorionic (DC) pregnancies, 14.8% and 29.6% of the MC pregnancies had structural anomalies in one or both fetuses (odds ratio = 5.774, 95% CI = 1.445-23.071, = 0.01) and twin-specific complications (odds ratio = 4.379, 95% CI = 1.641-11.684, = 0.03), respectively, compared to DC pregnancies with 2.9% for structural anomalies and 8.8% for twin-specific complications. The prevalence of abnormal fetal karyotypes was not statistically different in patients with INT when compared between MC and DC pregnancies ( = 0.329). INT was associated with a higher rate of twin-specific complications and fetal structural anomalies in MC twin pregnancies rather than abnormal fetal karyotype. Therefore, NT measurement in MC twin pregnancies can be a useful tool for predicting adverse pregnancy outcomes. Appropriate counseling and surveillance based on the chorionicity are imperative in the prenatal care of twin pregnancies.
基于绒毛膜性评估双胎妊娠中颈项透明层（INT）增厚的临床意义。这是一项对2006年1月至2014年12月期间在妊娠11 - 13周接受孕早期超声检查并测量颈项透明层（NT）的双胎妊娠进行的回顾性研究。数据通过产科数据库和病历审查收集。分析妊娠结局，包括分娩孕周、胎儿染色体异常、胎儿结构异常以及双胎特异性并发症。共识别出1622例一个或两个胎儿INT≥第95百分位数的双胎妊娠。在所有INT的双胎妊娠中，与NT正常的妊娠相比，17例（8.6%）患者被诊断出胎儿染色体异常（比值比 = 13.28，CI = 5.990 - 29.447，P = 0.000），23例（11.6%）患者出现双胎特异性并发症（比值比 = 2.398，CI = 1.463 - 3.928，P = 0.001）。在INT组中，当将妊娠分为单绒毛膜（MC）和双绒毛膜（DC）妊娠时，与DC妊娠相比，MC妊娠中分别有14.8%和29.6%的一个或两个胎儿存在结构异常（比值比 = 5.774，95% CI = 1.445 - 23.071，P = 0.01）以及双胎特异性并发症（比值比 = 4.379，95% CI = 1.641 - 11.684，P = 0.03），DC妊娠中结构异常的发生率为2.9%，双胎特异性并发症的发生率为8.8%。MC和DC妊娠中INT患者胎儿染色体异常的发生率无统计学差异（P = 0.329）。INT与MC双胎妊娠中双胎特异性并发症和胎儿结构异常的发生率较高相关，而非与胎儿染色体异常相关。因此，MC双胎妊娠中的NT测量可作为预测不良妊娠结局的有用工具。在双胎妊娠的产前护理中，基于绒毛膜性进行适当的咨询和监测至关重要。
