目的:探讨双胎妊娠早期子宫动脉多普勒与妊娠高血压疾病的关系。
方法:这是一项在里斯本市中心大学医院中心进行的双胎妊娠的回顾性队列研究,葡萄牙,2010年1月至2022年12月。测定妊娠早期子宫动脉搏动指数(UtA-PI),并比较双胎妊娠(n=454)和单胎妊娠(n=908),与母体和妊娠特征相匹配。母亲特征和平均UtA-PI分析了胎龄,出生体重,妊娠期高血压,早发型和晚发型先兆子痫,HELLP(溶血,肝酶升高,低血小板)综合征,和早产。使用单变量和多变量逻辑回归模型。
结果:双胎双胎的早孕平均UtA-PI明显低于单胎(P<0.001)。研究双胞胎妊娠高血压疾病,包括390例怀孕:311(79.7%)双胎和79(20.3%)单绒毛膜双胞胎。观察到的早发型和晚发型先兆子痫的发生率,妊娠期高血压,HELLP综合征为1.0%,4.4%,7.4%,和1.5%,分别。我们使用UtA-PI第90百分位数的双胞胎对早发型先兆子痫的检出率为100%。然而,当单例参考文献被考虑时,检出率下降到50%。在第95百分位或以上的UtA-PI与32周前早产的几率增加相关(调整后的优势比4.1,95%置信区间1.0-16.7,P=0.043)。
结论:除非存在高血压疾病的其他主要危险因素,UtA-PI低的女性可能不会从阿司匹林预防中受益。仍然建议密切监测所有双胎妊娠的高血压疾病。
OBJECTIVE: To determine the association of first-trimester uterine artery Doppler with hypertensive disorders of pregnancy in twin pregnancies.
METHODS: This was a retrospective cohort study of twin pregnancies followed at the University Hospital Center of Central Lisbon, Portugal, between January 2010 and December 2022. First-trimester uterine artery pulsatility index (UtA-PI) was determined and compared between twin pregnancies (n = 454) and singleton pregnancies (n = 908), matched to maternal and pregnancy characteristics. Maternal characteristics and mean UtA-PI were analyzed for gestational age, birth weight, gestational hypertension, early- and late-onset pre-eclampsia, HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome, and preterm birth. Univariable and multivariable logistic regression models were used.
RESULTS: The mean first-trimester UtA-PI was significantly lower in dichorionic twins than in singletons (P < 0.001). To study hypertensive disorders of pregnancy in twins, 390 pregnancies were included: 311 (79.7%) dichorionic and 79 (20.3%) monochorionic twins. The observed rates of early- and late-onset pre-eclampsia, gestational hypertension, and HELLP syndrome were 1.0%, 4.4%, 7.4%, and 1.5%, respectively. We achieved a 100% detection rate for early-onset pre-eclampsia using the UtA-PI 90th centile for twins. However, when singleton references were considered, the detection rate decreased to 50%. UtA-PI at or above the 95th centile was associated with increased odds for preterm birth before 32 weeks (adjusted odds ratio 4.1, 95% confidence interval 1.0-16.7, P = 0.043).
CONCLUSIONS: Unless other major risk factors for hypertensive disorders are present, women with low UtA-PI will probably not benefit from aspirin prophylaxis. Close monitoring of all twin pregnancies for hypertensive disorders is still recommended.