孕11-13^(+6)周超声检查预测复杂性双绒毛膜双胎的价值

First trimester ultrasound in the prediction of complicated dichorionic twins

目的探讨孕11-13+6周双胎间头臀长(CRL)、颈项透明层厚度(NT)、最大羊水深度(DVP)的差异对复杂性双绒毛膜双羊膜囊双胎的预测价值。方法对212例孕11-13+6周行超声检查确定为双绒毛膜双羊膜囊双活胎的孕妇,随访至妊娠结束,评估双胎间CRL、NT、DVP的差异与复杂性双胎(包括双胎生长不一致、选择性宫内生长受限(s FGR)、双胎之一死胎、双胎之一畸形)的相关性。结果 212例双绒毛膜双胎中有36例复杂性双胎(双胎之一死胎4例、双胎之一畸形2例,双胎生长不一致或选择性宫内生长受限30例)。复杂性双胎组即研究组早孕B超大小胎CRL、NT、DVP均值相比差异无统计学意义(P均>0.05)。非复杂性双胎组即对照组早孕B超大小胎NT、DVP均值相比差异无统计学意义(P均>0.05),CRL均值差异有统计学意义(t=1.326,P<0.01)。研究组与对照组相比,双胎间的CRL、NT、DVP差别均无统计学意义(P均>0.05)。结论非复杂性双胎在孕早期生长发育存在不均衡性,但孕早期双胎间CRL、NT、DVP的差异无法准确预测复杂性双绒毛膜双胎妊娠的发生。

Objective The purpose of this study was to determine whether first trimester ultrasoundscanning can identify dichorionic twin gestations that are at risk for subsequent adverse outcome. Methods 212 dichorionic twin pregnancies that were assessed by ultrasound examinations between 11 and 13+6 weeksof gestation were followed. Inter-twin differences of crown-rump length(CRL), nuchal translucency(NT) anddeepest vertical pockets(DVP) were calculated and compared between those with normal outcome and thosedeveloping adverse outcome including growth discordance, selective fetal growth restriction(s FGR), fetal deathof one twin and fetal malformation of one twin. Results Of 212 twin pregnancies, 36 pregnancies developedadverse outcome(4 fetal death of one twin, 2 fetal malformation of one twin and 30 growth discordance ors FGR). The inter-twin CRL, NT and DVP were not significantly different(all P>0.05) in adverse outcomegroup. The inter-twin NT and DVP were not significantly different(all P>0.05) in control group. The inter-twinCRL was significantly different(P<0.001) in control group. Inter-twin differences of CRL, NT and DVP werenot significantly different between adverse outcome group and normal outcome group. Conclusions First-trimester CRL, NT and DVP inter-twin differences were not predictive of subsequent adverse outcome indichorionic twins, although CRL discrepancy happened in the first trimester.