Public Health School, Medical College of Qingdao University, Qingdao, China.
Qingdao Women and Children's Hospital, Qingdao University, Qingdao, China.
PLoS One. 2021 Aug 9;16(8):e0255897. doi: 10.1371/journal.pone.0255897. eCollection 2021.
Selective fetal restriction growth (sFGR) is one of the common diseases of monochorionic diamniotic (MCDA) twin pregnancies, resulting in many adverse outcomes. At present, second trimester ultrasonography is widely used in the prenatal diagnosis of sFGR, but the diagnostic effectiveness is still uncertain. The aim of this study is to assess the diagnostic accuracy of second trimester Doppler ultrasound measurements for sFGR.
A retrospective study included 280 pregnant women (118 with and 162 without sFGR) with MCDA pregnancies was conducted in the fetal medicine center from Leiden University Medical Center from January 2008 to December 2013. The women participating had already undergone an ultrasound examination in the second trimester. The postnatal criteria of sFGR was a single birth weight (BW) < 3 rd percentile in a twin, or birth weight discordance (BWD)≥25% between two twins, while the BW of the smaller twin < 10th percentile. Early prenatal diagnosis of sFGR was defined as a single EFW < 3 rd percentile in a twin, or at least 2 of the following 4 parameters must be met (fetal weight of one fetus < 10th percentile, AC of one fetus <10th percentile, EFW discordance≥25%, UA pulsatility index (PI) of the smaller fetus > 95th percentile). According to the diagnosis of sFGR after birth, we evaluate diagnostic effectiveness of Doppler ultrasound in the second trimester for sFGR.
Of these 280 participants, the mean age was 32.06 ± 4.76 years. About 43.9% of pregnant women were primiparas. The ability of second trimester Doppler ultrasound to accurately diagnosed sFGR is 75.4%, missed diagnosis rate and the misdiagnosis rate were 24.6% and 10.5% respectively. The ROC curve indicated that the combination of AC discordance, EFW discordance, and small fetal UA blood flow was the best diagnostic indicator of sFGR in MCDA pregnancy with the AUC was 0.882 (95%CI, 0.839-0.926).
Second trimester Doppler and ultrasound measurements is an effective method for early prenatal diagnosis of sFGR. The combined indicator of AC discordance, EFW discordance, and the small fetal UA blood flow reaches highest diagnostic value.
选择性胎儿生长受限（sFGR）是单绒毛膜双羊膜囊（MCDA）双胎妊娠的常见疾病之一，可导致多种不良结局。目前，中孕期超声检查广泛应用于 sFGR 的产前诊断，但诊断效能仍不确定。本研究旨在评估中孕期多普勒超声测量对 sFGR 的诊断准确性。
本研究为回顾性研究，纳入 2008 年 1 月至 2013 年 12 月莱顿大学医学中心胎儿医学中心的 280 例 MCDA 妊娠孕妇，其中 118 例患有 sFGR，162 例无 sFGR。这些孕妇均已行中孕期超声检查。sFGR 的产后标准为单胎出生体重（BW）<第 3 百分位数，或双胎 BW 差异（BWD）≥25%，或较小胎儿 BW<第 10 百分位数。sFGR 的早期产前诊断定义为双胎中单一胎儿的估计胎儿体重（EFW）<第 3 百分位数，或至少有以下 4 个参数中的 2 个必须满足（一个胎儿的胎儿大小<第 10 百分位数，一个胎儿的 AC<第 10 百分位数，EFW 差异≥25%，较小胎儿的 UA 搏动指数（PI）>第 95 百分位数）。根据产后 sFGR 的诊断，我们评估中孕期多普勒超声对 sFGR 的诊断效果。
在这 280 名参与者中，平均年龄为 32.06 ± 4.76 岁。约 43.9%的孕妇为初产妇。中孕期多普勒超声准确诊断 sFGR 的能力为 75.4%，漏诊率和误诊率分别为 24.6%和 10.5%。ROC 曲线表明，AC 差异、EFW 差异和小胎儿 UA 血流的联合是诊断 MCDA 妊娠 sFGR 的最佳诊断指标，AUC 为 0.882（95%CI，0.839-0.926）。
中孕期多普勒超声测量是 sFGR 产前早期诊断的有效方法。AC 差异、EFW 差异和小胎儿 UA 血流的联合指标具有最高的诊断价值。
