目的:母体心功能在正常胎盘功能和发育中起着至关重要的作用。双胎妊娠的母体血流动力学变化比单胎妊娠更为明显,可能是由于等离子体体积膨胀增加。鉴于心脏和胎盘功能之间的相关性,绒毛膜可能会影响母体的心脏功能。这项研究的目的是比较双胎和单绒毛膜双胎妊娠的纵向母体血液动力学变化。
方法:40个单绒毛膜羊膜(MC),研究中包括35例二胎性羊膜(DC)无并发症的双胎妊娠。来自横断面研究的531例健康单胎妊娠被用作对照组。所有参与者在妊娠的三个不同阶段(11-15周,20-24周和29-33周)记录平均动脉压(MAP),每搏输出量(SV),每搏量指数(SVI)心率(HR),心输出量(CO),心脏指数(CI),全身血管阻力(SVR),全身血管阻力指数(SVI),每搏量变化(SVV),史密斯-马迪根内渗指数(INO)和势能与动能比(PKR)。
结果:孕产妇CO(8.33vs7.30l/min,p=0.03)和CI(4.52对4.00l/min/m2,与DC双胎妊娠相比,在MC的孕中期,p=0.02)明显更高。MC双胎妊娠妇女的PKR(24.06vs20.13,p=0.03)和SVRI(1837.20vs1698.49d.s.cm-5/m2,p=0.03)在妊娠晚期,和显著较低的SV值(78.80vs88.80cm3,p=0.01),SVI(47.00对50.31cm3/m2,p<0.01)和INO(1.70vs1.87W/m2,p=0.03)与单身怀孕.在DC双胎妊娠中未观察到这些差异。
结论:在无并发症的双胎妊娠期间,母体的心血管功能发生了显著的变化,并且绒毛膜会影响母体的血流动力学。在两个双胎妊娠中,早在妊娠早期就检测到血液动力学变化。在DC双胎妊娠中,母体血液动力学在其余妊娠期间保持稳定。相反,在MC双胎妊娠中,妊娠中期母体CO继续上升,以维持较高的胎盘生长。在妊娠晚期,心血管性能会降低,随后会出现交叉。本文受版权保护。保留所有权利。
Maternal cardiac function plays a crucial role in placental function and development. The maternal hemodynamic changes in twin pregnancy are more pronounced than those in singleton pregnancy, presumably due to a greater plasma volume expansion. In view of the correlation between maternal cardiac and placental function, it is plausible that chorionicity could influence maternal cardiac function. The aim of this study was to compare the longitudinal maternal hemodynamic changes between uncomplicated dichorionic (DC) and monochorionic (MC) twin pregnancies and in comparison to singleton pregnancies.
Included in the study were 40 MC diamniotic and 35 DC diamniotic uncomplicated twin pregnancies. These were compared with a group of 294 healthy singleton pregnancies from a previous cross-sectional study. All participants underwent a hemodynamic evaluation using an Ultrasound Cardiac Output Monitor (USCOM®), at three different stages in pregnancy (11-15 weeks, 20-24 weeks and 29-33 weeks). The following parameters were recorded: mean arterial pressure (MAP), stroke volume (SV), stroke volume index (SVI), heart rate, cardiac output (CO), cardiac index (CI), systemic vascular resistance (SVR), systemic vascular resistance index (SVRI), stroke volume variation, Smith-Madigan inotropy index (INO) and potential-to-kinetic-energy ratio (PKR).
In the first trimester, DC and MC twin pregnancies showed lower MAP, SVR and PKR and higher CO and SV in comparison to singleton pregnancy. In the second trimester, maternal CO (8.33 vs 7.30 L/min, P = 0.03) and CI (4.52 vs 4.00 L/min/m2 , P = 0.02) were significantly higher in MC compared with DC twin pregnancy. In the third trimester, compared with in singleton pregnancy, women with MC twin pregnancy showed significantly higher PKR (24.06 vs 20.13, P = 0.03) and SVRI (1837.20 vs 1698.48 dynes × s/cm5 /m2 , P = 0.03), and significantly lower SV (78.80 vs 88.80 mL, P = 0.01), SVI (42.79 vs 50.31 mL/m2 , P < 0.01) and INO (1.70 vs 1.87 W/m2 , P = 0.03); these differences were not observed between DC twin and singleton pregnancies.
Maternal cardiovascular function undergoes significant change during uncomplicated twin pregnancy and chorionicity influences maternal hemodynamics. In both MC and DC twin pregnancy, hemodynamic changes are detectable as early as the first trimester, showing higher maternal CO and lower SVR compared with singleton pregnancy. In DC twin pregnancy, the maternal hemodynamics remain stable during the rest of pregnancy. In contrast, in MC twin pregnancy, the rise in maternal CO continues in the second trimester in order to sustain the greater placental growth. There is a subsequent crossover, with a reduction in cardiovascular performance during the third trimester. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.