双胎生长不一致的模式对产科不良结局的影响

Inconsistent patterns of twin growth and their relationship with obstetric adverse outcomes

目的确定双胎妊娠中双胎生长不一致的模式对产科不良结局的影响。方法回顾性分析2014年1月至2021年12月在笔者医院进行产检和分娩的531例双胎妊娠孕产妇的病历资料。根据产检时的超声参数,将双胎间的不一致性分为4个模式,即:模式1:无显著不一致性组(268例)、模式2:早期进行性不一致(23例)、模式3:早期不一致伴平台期(91例)和模式4:晚期不一致(149例)。考察各模式动态变化规律及其与不良结局的相关性。结果模式2和模式3不一致性>10%(孕20.5周和20.7周)和>20%(孕27.7周和26.3周)发生时间相似。模式2不一致进展率最高(0.92%/周),孕36周时不一致达到峰值23.7%。模式3的进展速度较慢(0.49%/周),孕20周后的不一致幅度变化较小(从孕20周13.3%至孕36周16%)。模式4>10%的不一致开始时间在孕29.8周,不一致峰值(14.8%)低于模式2和模式3。使用模式1(无显著不一致)作为参照,在调整了相关协变量后,模式2和模式3是妊娠34和32周时早产和子痫前期的危险因素,模式2是5min Apgar评分<7分的危险因素,模式2、3和4是新生儿出生体质量<第10百分位数的危险因素。结论根据胎儿生长不一致性的发生、发展和强度识别出的4种不同的不一致性模式各自与不同的产科结局具有相关性。这些模式比通常使用的单个时间点测量胎儿生长不一致能提供更多的预测信息。

Objective To determine different patterns of fetal growth dissonance in twin pregnancies and their predictive role in obstetric adverse outcomes.Methods The medical records of 531cases of twin-pregnancy women who underwent labor examination and delivery in our hospital from January 2014 to december 2021 were retrospectively analyzed.According to the ultrasound parameters during the prenatal examination,the inconsistencies between twins were divided into four modes:mode 1:no significant inconsistencies group(268cases),Mode 2:early progressive inconsistencies(23cases),mode 3:early inconsistencies with plinosis(91cases)and mode 4:late inconsistencies(149cases).The dynamic changes of each model and its correlation with adverse outcomes were investigated.Results Pattern 2 and Pattern 3 inconsistencies>10%(20.5 and 20.7 weeks of gestation)and>20%(27.7 and 26.3weeks of gestation)occurred at similar times.Mode 2 had the highest rate of inconsistent progression(0.92%/week),which peaked at 23.7%at 36weeks of gestation.Mode 3 progressed at a slower rate(0.49%/week),with a smaller variance after 20weeks(from 13.3%at 20weeks to 16%at 36weeks).The onset time of pattern 4 inconsistencies was>10%at 29.8weeks of gestation,and the peak inconsistencies(14.8%)were lower than pattern 2 and pattern Using mode 1(no significant inconsistency)as a reference,after adjusting for relevant covariates,mode 2 and 3 were risk factors for preterm birth and preeclampsia at 34 and 32weeks of gestation,mode 2 was a risk factor for 5-minute Apgar score<7,and mode 2,3,and 4 were risk factors for newborn birth weight<10th percentile.Conclusion According to the occurrence,development and intensity of neonatal growth dissonance,four different dissonance patterns were identified to be associated with different obstetric outcomes.These models provide more predictive information than the single point in time when measurements of fetal size are inconsistent,which is commonly used.