双胎之一脐血流S/D值增高对两胎儿结局的影响研究

Study on the effect of the increase of S/D ratio of umbilical cord blood flow in twins on the outcome of both fetuses

目的研究了双胎之一脐血流收缩末期峰值(S)/舒张末期峰值(D)值增高对两胎儿结局的影响。方法回顾性选择2017年3月至2020年3月在西北妇女儿童医院行产检并确定分娩的双胎之一胎儿S/D值≥3的孕妇41例设为异常组,另选择同期双胎胎儿S/D值均<3的孕妇45例纳入正常组。每组根据双胎情况分为两个亚组,即单绒毛膜双羊膜囊双胎(MCDA)组及双绒毛膜双羊膜囊双胎(DCDA)组。比较异常组与正常组脐血流搏动指数(PI)、阻力指数(RI)及大脑中动脉S/D值;比较两组及亚组间围产期并发症发生率,包括胎儿窘迫、发育不均衡、脐带绕颈、早产等;两组及亚组间围产儿预后,包括胎儿宫内生长受限(FGR)、Apgar评分、呼吸窘迫综合征、围产儿预后不良等。结果异常组脐血流PI、RI及大脑中动脉S/D值均较正常组低(1.02±0.22vs.1.12±0.24、0.63±0.13vs.0.69±0.15、4.72±0.81vs.5.02±0.83),差异有统计学意义(P<0.05)。异常组胎儿窘迫、胎死宫内、发育不均衡、早产、脐带绕颈发生率明显高于正常组,在异常组及正常组内,MCDA组围产期并发症发生率均较DCDA组高,而MCDA及DCDA在异常组的围产期并发症发生率较在正常组高,差异均有统计学意义(P<0.05);在两组分娩孕周比较中,异常组分娩孕周<36周的占51.22%,明显高于正常组(P<0.05),而足月产率0%,明显低于正常组4.4%(P<0.05)。异常组FGR、Apgar评分及围产儿预后明显高于正常组;异常组中,MCDA组的FGR、新生儿缺血缺氧性脑病、Apgar评分、呼吸窘迫综合征、围产儿预后不良发生率均明显高于DCDA组;正常组中,MCDA组FGR、Apgar评分、呼吸窘迫综合征、围产儿预后不良发生率均明显高于DCDA组;MCDA组的围产儿预后不良发生率在异常组明显高于在正常组,差异有统计学意义(P<0.05)。结论脐血流检测简便、快捷、无创,是一种良好的产前监护手段,有助于对双胎妊娠的产前筛查以及管理,临床对双胎之一S/D值异常,特别是MCDA双胎的胎儿,应及时采取干预措施,以降低围产儿不良预后的发生风险。

Objective To study the effect of increased S/D ratio of one of the twin fetal cord blood flow on two fetal outcomes.Methods From March 2017 to March 2020,41 pregnant women with fetal S/D value≥3 were selected as abnormal group,and 45 pregnant women with twin fetal S/D value<3 in the same period were included in the normal group.Each group was divided into two subgroups according to the situation of twins,namely monochorionic diamniotic twin(MCDA)group and dichorionic diamniotic twin(DCDA)group.Cord blood flow pulsatility index(PI),resistance index(RI)and middle cerebral artery S/D values were compared in the abnormal group and the normal group.The incidence of perinatal complications was compared between the two groups and subgroups,included fetal distress,developmental imbalance,umbilical cord around the neck,premature delivery,and so on;the perinatal prognosis between the two groups and subgroups included FGR,Apgar score,respiratory distress syndrome,poor perinatal prognosis,and so on.Results The umbilical cord blood flow PI,RI and middle cerebral artery S/D values of the abnormal group were lower than those of the normal group(1.02±0.22 vs.1.12±0.24,0.63±0.13 vs.0.69±0.15,4.72±0.81 vs.5.02±0.83).The differences were statistically significant(P<0.05).The incidence of fetal distress,intrauterine fetal death,unbalanced development,premature delivery and umbilical cord around neck in abnormal group was significantly higher than that in normal group.In abnormal group and normal group,the incidence of perinatal complications in MCDA group was higher than that in DCDA group,while the incidence of perinatal complications in abnormal group was higher than that in normal group(P<0.05).In the comparison of gestational weeks between the two groups,the gestational week<36W in the abnormal group was 51.22%,which was significantly higher than that in the normal group(P<0.05),and the full-term rate was 0%,which was significantly lower than it of the normal group(4.4%)(P<0.05).FGR,Apgar score and perinatal prognosis of the abnormal group were significantly higher than those of the normal group.In the abnormal group,FGR,neonatal hypoxic-ischemic encephalopathy,Apgar score,respiratory distress syndrome and adverse perinatal prognosis of the MCDA group were significantly higher than those of the DCDA group.In the normal group,FGR,Apgar score,respiratory distress syndrome and adverse perinatal prognosis of the MCDA group were significantly higher than those of the DCDA group;The incidence of poor perinatal prognosis in the MCDA group was significantly higher in the abnormal group than in the normal group,the above differences are statistically significant(P<0.05).Conclusion Umbilical blood flow detection is simple,rapid and non-invasive,which is a good prenatal monitoring method and is helpful for prenatal screening and management of twin pregnancy.In clinical practice,for a fetus with an abnormal S/D value of twins,especially the twin of MCDA,interventions should be taken in time to reduce the risk of poor prognosis in perinatal children.