Tran Thi Thuy Phuong, Trinh Nhut Thu Huong, Dang Minh Doan, Ho Nguyen Thi Hong Cuc, Nguyen Phuc Nhon
Department of Prenatal Diagnosis, Tu Du Hospital, 284 CONG QUYNH, HO CHI MINH, 71012, Vietnam.
Cinical Research Center (CRC), Tu Du Hospital, 284 CONG QUYNH, HO CHI MINH, 71012, Vietnam.
Int J Gynaecol Obstet. 2025 Jul;170(1):478-488. doi: 10.1002/ijgo.70018. Epub 2025 Feb 20.
To evaluate the usefulness of first-trimester crown-rump length (CRL) and nuchal translucency (NT) thickness discordance in predicting adverse outcomes in monochorionic diamniotic (MCDA) twin pregnancies.
This retrospective cohort study enrolled MCDA twin pregnancies in which CRL and NT were measured at 11-13 weeks of pregnancy and collected for pregnancy outcomes between January 2022 and June 2023 at Tu Du Hospital in Vietnam. The intertwin discrepancy of CRL and NT was calculated as a percentage of the larger fetuses and smaller fetuses. Regression analysis was used to determine the significance of the association between the intertwin discordance in NT and CRL and the development of twin-to-twin transfusion syndrome (TTTS), fetal growth restriction (FGR), intrauterine fetal demise (IUFD), and those with normal outcomes. Receiver operating characteristic curves were constructed to evaluate the performance of inter-twin discrepancy in the prediction of FGR, TTTS, and IUFD.
A total of 294 MCDA twin pregnancies were studied. Among them, 149 cases (50.7%) had at least one adverse outcome. The complications included TTTS in 82 cases (55.0%), FGR in 89 cases (59.7%), one IUFD in 95 cases (63.8%), and two IUFDs in 19 cases (12.8%). CRL discordance greater than 10.0% and NT discordance greater than 20.0% were not related to TTTS and IUFD, only to FGR. A CRL discordance greater than 20.0% decreased the survival rate of fetuses. CRL discordance greater than 10.0% had specificity in diagnosing TTTS, IUFD, and FGR of more than 80%, whereas, NT discordance greater than 20.0% had specificity in detecting these complications of more than 50.0%. A predictive model including CRL and NT discordance showed a poor value with area under the curve of:0.69 (95% confidence interval 0.69-0.75).
In MCDA twin pregnancies, discordant CRL greater than 10.0% was related to FGR. Meanwhile, an intertwin discordance of NT thickness greater than 20.0% was not related to TTTS, FGR, and IUFD. However, adequate surveillance is still required.
评估孕早期头臀长（CRL）和颈项透明层（NT）厚度不一致在预测单绒毛膜双羊膜囊（MCDA）双胎妊娠不良结局中的作用。
这项回顾性队列研究纳入了在越南图度医院于2022年1月至2023年6月期间进行的MCDA双胎妊娠，这些妊娠在孕11 - 13周时测量了CRL和NT，并收集了妊娠结局。CRL和NT的双胎间差异以较大胎儿与较小胎儿的百分比计算。采用回归分析来确定NT和CRL的双胎间不一致与双胎输血综合征（TTTS）、胎儿生长受限（FGR）、宫内胎儿死亡（IUFD）以及结局正常者之间关联的显著性。构建受试者工作特征曲线以评估双胎间差异在预测FGR、TTTS和IUFD方面的性能。
共研究了294例MCDA双胎妊娠。其中，149例（50.7%）至少有一项不良结局。并发症包括82例（55.0%）TTTS、89例（59.7%）FGR、95例中有1例IUFD（63.8%）以及19例中有2例IUFD（12.8%）。CRL不一致大于10.0%和NT不一致大于20.0%与TTTS和IUFD无关，仅与FGR有关。CRL不一致大于20.0%会降低胎儿存活率。CRL不一致大于10.0%在诊断TTTS、IUFD和FGR方面的特异性超过80%，而NT不一致大于20.0%在检测这些并发症方面的特异性超过50.0%。一个包含CRL和NT不一致的预测模型显示其曲线下面积值较差：0.69（95%置信区间0.69 - 0.75）。
在MCDA双胎妊娠中，CRL不一致大于10.0%与FGR有关。同时，NT厚度双胎间不一致大于20.0%与TTTS、FGR和IUFD无关。然而，仍需要进行充分的监测。
