Litwinska Ewelina, Litwinska Magdalena, Czuba Bartosz, Gach Agnieszka, Kwiatkowski Sebastian, Kosinski Przemyslaw, Kaczmarek Piotr, Wielgos Miroslaw
1st Department of Obstetrics and Gynecology, Medical University of Warsaw, 03-242 Warsaw, Poland.
Women's Health, Faculty of Health Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland.
J Clin Med. 2022 Mar 31;11(7):1937. doi: 10.3390/jcm11071937.
This study aims to determine if second trimester amniocentesis in twin pregnancies provides a significant independent contribution in the prediction of miscarriage or fetal loss at any stage of pregnancy. This was a retrospective cohort study of women with twin gestations booked for routine prenatal care in four fetal medicine units in Poland in the years 2010-2020. The study population included: (1) twin pregnancies that underwent amniocentesis at 16-20 weeks' gestation; (2) twin pregnancies that did not require any further testing and were followed-up routinely. Univariable and multivariable regression analysis was used to define which maternal and pregnancy characteristics provided a significant independent contribution in the prediction of miscarriage and fetal loss at any stage of pregnancy. In the study period, 2645 twin pregnancies were eligible for analysis. There were 144 cases of miscarriage defined as fetal loss of one or both twins before 24 weeks and 40 cases of intrauterine death of one or both twins after 24 weeks. A total number of 162 twin pregnancies underwent amniocentesis at 16-20 weeks' gestation. The rate of miscarriage before 24 weeks and the rate of fetal loss at any stage of pregnancy in the group that underwent amniocentesis was 10.49% and 13.58%, respectively, compared to 5.11% and 6.52% that did not undergo amniocentesis. Multivariable regression analysis showed that factors providing a significant independent contribution in the prediction of miscarriage and fetal loss at any stage of pregnancy were monochorionicity (MC), large intertwin discordance in crown-rump length (CRL), low Pregnancy Related Plasma Protein (PAPP-A) MoM and nuchal translucency (NT) above 95th centile. Amniocentesis in twin pregnancies does not provide a significant contribution in the prediction of miscarriage or fetal loss at any stage of pregnancy.
本研究旨在确定双胎妊娠中期羊膜腔穿刺术在预测孕期任何阶段流产或胎儿丢失方面是否能提供显著的独立贡献。这是一项对2010年至2020年在波兰四个胎儿医学单位进行常规产前检查的双胎妊娠女性的回顾性队列研究。研究人群包括：（1）妊娠16 - 20周时接受羊膜腔穿刺术的双胎妊娠；（2）不需要进一步检查并接受常规随访的双胎妊娠。采用单变量和多变量回归分析来确定哪些母体和妊娠特征在预测孕期任何阶段流产和胎儿丢失方面能提供显著的独立贡献。在研究期间，2645例双胎妊娠符合分析条件。有144例流产被定义为24周前一个或两个胎儿丢失，40例为24周后一个或两个胎儿宫内死亡。共有162例双胎妊娠在妊娠16 - 20周时接受了羊膜腔穿刺术。接受羊膜腔穿刺术的组中，24周前流产率和孕期任何阶段胎儿丢失率分别为10.49%和13.58%，而未接受羊膜腔穿刺术的组分别为5.11%和6.52%。多变量回归分析表明，在预测孕期任何阶段流产和胎儿丢失方面提供显著独立贡献的因素是单绒毛膜性（MC）、顶臀长（CRL）双胎间差异大、妊娠相关血浆蛋白（PAPP - A）中位数倍数（MoM）低以及颈项透明层（NT）高于第95百分位数。双胎妊娠的羊膜腔穿刺术在预测孕期任何阶段流产或胎儿丢失方面没有显著贡献。
