Fetal Therapy Unit 'Umberto Nicolini', Buzzi Children's Hospital, Milan, Italy.
Department of Women, Mother and Newborn, Buzzi Children's Hospital, University of Milan, Milan, Italy.
Ultrasound Obstet Gynecol. 2023 Apr;61(4):504-510. doi: 10.1002/uog.26098.
To evaluate the prevalence, subtypes and postnatal outcomes of congenital heart defects (CHD) in a cohort of monochorionic diamniotic (MCDA) twin pregnancies complicated by selective fetal growth restriction (sFGR), and to compare this population with a cohort of uncomplicated MCDA pregnancies evaluated during the same period.
This was a retrospective analysis of all consecutive MCDA pregnancies referred between 2009 and 2018, including those complicated by sFGR (Group A) and those without complications (Group B). All neonates delivered in our center were screened for CHD before discharge. Discharge letters for all those delivered elsewhere were retrieved. Pregnancies with complications other than sFGR and those without perinatal follow-up were excluded. Pregnancies in Group A were divided into three types according to the Gratacós system of sFGR classification.
A total of 870 MCDA twin pregnancies were included: 296 in Group A and 574 in Group B. In Group A, the prevalence of CHD was 3.7% (22/592 twins), with no significant difference in CHD frequency between the three types of sFGR (Type I, 3.7%; Type II, 3.2%; Type III, 4.2%; P = 0.55). Of four Type-III sFGR pregnancies with CHD, one had pulmonary stenosis (PS) in the larger twin and isolated coarctation of the aorta in the smaller cotwin, and three had PS in the larger twin only. No Type-III sFGR pregnancies in which only the smaller twin was affected by CHD were observed. Of 11 CHD cases in the larger twin, 10 (91%) were right ventricular outflow tract abnormalities (RVOTA), and one (9%) was a ventricular septal defect. In the smaller twins, 11 cases of CHD were observed, covering a broad spectrum of cardiac abnormalities. In Group B, the CHD prevalence was 1.1% (13/1148 twins), which was similar to that in the general population, according to the EUROCAT registry for the same period and geographical area of the study (0.96%; P = 0.579). The CHD prevalence was significantly higher in Group A compared with Group B (3.7% vs 1.1%; P = 0.0002; odds ratio, 3.57 (95% CI, 1.78-7.22)). In all pregnancies with CHD in the study population, the anomaly was discordant.
In MCDA twin pregnancy, sFGR was associated with a three-fold higher prevalence of CHD. Women with such pregnancies should be referred to a tertiary care hospital for pre- and postnatal cardiac evaluation, treatment and long-term follow-up. In larger twins, the only major CHD observed was RVOTA, while a broad spectrum of CHD was noted in smaller twins. The higher risk of CHD in MCDA pregnancies appears to be due to the typical complications of the monochorionic pregnancy, rather than to the monochorionic nature of the pregnancy itself. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
评估在选择性胎儿生长受限（sFGR）合并的单绒毛膜双羊膜囊（MCDA）双胎妊娠队列中先天性心脏缺陷（CHD）的患病率、亚型和产后结局，并将该人群与同期评估的无并发症 MCDA 妊娠队列进行比较。
这是一项对 2009 年至 2018 年连续转诊的所有 MCDA 妊娠的回顾性分析，包括合并 sFGR（A 组）和无并发症（B 组）的妊娠。我们中心所有分娩的新生儿在出院前均进行 CHD 筛查。检索了所有在其他地方分娩的新生儿的出院记录。排除了有并发症（除 sFGR 外）和无围产期随访的妊娠。根据 Gratacós 的 sFGR 分类系统，将 A 组妊娠分为三种类型。
共纳入 870 例 MCDA 双胎妊娠：A 组 296 例，B 组 574 例。A 组中 CHD 的患病率为 3.7%（592 对双胞胎中的 22 对），三种类型的 sFGR 之间 CHD 的频率无显著差异（I 型 3.7%；II 型 3.2%；III 型 4.2%；P=0.55）。在 4 例 CHD 的 III 型 sFGR 妊娠中，1 例较大胎儿为肺动脉瓣狭窄（PS），较小胎儿为单纯主动脉缩窄，3 例仅较大胎儿为 PS。未观察到仅较小胎儿受 CHD 影响的 III 型 sFGR 妊娠。在较大胎儿中，11 例 CHD 中有 10 例（91%）为右心室流出道异常（RVOTA），1 例（9%）为室间隔缺损。在较小的双胞胎中，观察到 11 例 CHD，涵盖了广泛的心脏异常。B 组中 CHD 的患病率为 1.1%（1148 对双胞胎中的 13 对），与同期和研究地区 EUROCAT 登记处的一般人群患病率（0.96%）相似（P=0.579）。与 B 组相比，A 组 CHD 的患病率显著更高（3.7%比 1.1%；P=0.0002；比值比，3.57（95%CI，1.78-7.22））。在研究人群中所有患有 CHD 的妊娠中，异常均不一致。
在 MCDA 双胎妊娠中，sFGR 与 CHD 的患病率增加三倍相关。有此类妊娠的女性应转至三级保健医院进行产前和产后心脏评估、治疗和长期随访。在较大的胎儿中，仅观察到主要的 CHD 为 RVOTA，而较小的胎儿中则观察到广泛的 CHD。MCDA 妊娠中 CHD 风险增加似乎是由于单绒毛膜妊娠的典型并发症所致，而不是由于妊娠本身的单绒毛膜性质所致。
