双胎脐带插入方式与双胎不良妊娠结局的临床研究

Umbilical Cord Insertion Variants Involve with Adverse Pregnancy Outcome in Twin Pregnancy

目的:实施前瞻性研究探讨双胎脐带插入方式与双胎特有不良妊娠结局的关系。方法:选择2015年6月至2019年6月在四川大学华西第二医院就诊,孕11~14周经超声筛查为单绒毛膜双胎(MCDA)及双绒毛膜双胎(DCDA)孕妇,根据脐带插入方式分为脐带异常插入组(包括边缘性插入组及帆状插入组)和正常插入组。并比较不同插入方式的不良妊娠结局[双胎胎儿体质量相差大于25%(EFW>25%)、选择性胎儿生长受限(sFGR)、双胎输血综合征(TTTS)]。结果:(1)共纳入319例双胎,DCDA 213例(66.8%),MCDA 106例(33.2%);边缘性脐带插入113例(35.4%),帆状插入42例(13.2%),正常脐带插入164例(51.4%)。(2)MCDA双胎中脐带帆状插入在诊断为sFGR(OR 8.55,P<0.05)、TTTS(OR 5.33,P<0.05)、EFW>25%(OR 4.27,P<0.05)中的比例明显高于正常插入组,差异有统计学意义;而其边缘性插入在诊断为以上三项中的比例与正常插入组比较,差异无统计学意义(P>0.05)。DCDA双胎中脐带帆状插入率与边缘性插入率在EFW>25%、sFGR中分别与正常插入组比较,差异均无统计学意义(P>0.05)。(3)边缘性插入组和帆状插入组中双胎中较小胎儿的发生率均高于正常插入组(P<0.05)。结论:脐带帆状插入在MCDA双胎中发生不良妊娠结局的风险较高,而脐带帆状插入与边缘性插入在DCDA双胎中不良妊娠结局的风险不明显。孕期检查需要筛查脐带插入情况,能为双胎孕期管理提供有价值的依据。

Objective:To explore the relationship between the umbilical cord insertion variantsand the twin-specific pregnancy complications.Methods:Pregnant women from June 2015 to June 2019 in West China Second Hospital of Sichuan University,were diagnosed with monochorionic twins(MCDA)and double-chorionic twins(DCDA)by ultrasound screening at 11-14 weeks of pregnancy.They were divided into three groups(marginal insertion group,velamentous insertion group and normal insertion group)according to the umbilical cord insert positiondifferences.And the twin-specific pregnancy complications including birthweight discordancy(EFW difference>25%),selective fetal growth restriction(sFGR)and twin transfusion syndrome(TTTS)were compared in each group.Results:(1)A total of 319 cases of twin pregnancy were included 213(66.8%)DCDA,106(33.2%)MCDA),among them,113 cases(35.4%)of marginal insertion,42 cases(13.2%)of velamentous insertion and 164 cases(51.4%)of normal insertion.(2)The incidences of sFGR(OR 8.55,P<0.05),TTTS(OR 5.33,P<0.05)and birthweight discordancy(OR 4.27,P<0.05)in velamentous insertion group were significantly higher than normal insertion group in MCDA;but none of these applied to the marginal insertion group(P>0.05).No significant differences of the birthweight discordancy and sFGR incidencesin velamentous insertion group and marginal insertion groupin DCDA(P>0.05).(3)The incidence of smaller fetal size in both marginal insertion group and velamentous insertion group were higher than the normal insertion group(P<0.05).Conclusions:Umbilical cord velamentous insertion is strongly associated with of the twin-specific adverse pregnancy outcomes in MCDA,while no obvious correlation between the umbilical cord insertion variantsand the twin-specific adverse pregnancy outcomes in DCDA.Screeningthe umbilical cord insertion variants can provide a valuable basis for the management of twins during pregnancy.