■单绒毛膜羊膜(MCDA)双胎妊娠被认为是高风险的,原因有几个,尤其是双胞胎对双胞胎输血综合征(TTTS)的风险。据报道,肾动脉多普勒(RAD)是预测单胎妊娠羊水过少的有用工具。我们旨在比较有和没有TTTS的MCDA双胞胎之间的RAD指数。
■在本病例对照研究中,所有18-38岁的孕妇,胎龄≥18周,他们被转诊到两个产前诊所,Alzahra和Beheshti教育医院,隶属于伊斯法罕医科大学,伊斯法罕,伊朗,2020年10月至2022年3月登记;患有MCDA双胎妊娠并伴有TTTS的妇女(病例组,n=12)和无TTTS(对照组,n=24)。对于每个双胞胎来说,生物识别分析,胎儿体重,和胎儿动脉的多普勒研究,包括RAD,大脑中动脉(MCA),脐动脉,并进行了静脉导管。收缩期峰值速度,搏动指数(PI),阻力指数(RI),测量所有动脉的收缩期/舒张期(S/D)。
■病例组供体的平均MCAS/D(4.48±1.89)低于对照组(6.48±1.97)(P=0.01),平均脐带参数较高,包括PI,RI,S/D(P<0.05)。病例组的受者的平均肾脏PI低于对照组(P=0.008),平均MCAPI较低,RI,S/D(P<0.05)。供体组的平均脐带RI和S/D高于受体双胞胎,受者组平均胎儿体重较高(P<0.05)。
■在本研究中比较有和没有TTTS的双胞胎之间的RAD参数没有发现显著的结果,它拒绝了主要假设。在所有RAD参数中,本研究中观察到的唯一显著差异是RT中RADPI较低,这不能表明这种测量作为预测MCDA双胞胎中TTTS的有价值的工具。因此,本研究的结果未能显示RAD的附加价值,与常规的胎儿动脉多普勒检查相比。需要进一步的研究来证明这一结论。
UNASSIGNED: Monochorionic diamniotic (MCDA) twin pregnancies are considered high-risk for several reasons, especially the risk of twin-to-twin transfusion syndrome (TTTS). Renal artery Doppler (RAD) is reported as a useful tool for predicting oligohydramnios in singleton pregnancies. We aimed to compare the RAD indices between MCDA twins with and without TTTS.
UNASSIGNED: In this case-control study, all pregnant women aged 18-38 years, with gestational age ≥ 18 weeks, who were referred to two Prenatal Clinics, Alzahra and Beheshti Educational Hospitals, affiliated to Isfahan University of Medical Sciences, Isfahan, Iran, October 2020-March 2022 were enrolled; the women with MCDA twin pregnancies complicated by TTTS (case group, n = 12) and without TTTS (control group, n = 24). For each twin, biometric analysis, fetal weight, and Doppler study of fetal arteries, including RAD, middle cerebral artery (MCA), umbilical artery, and ductus venosus were performed. Peak systolic velocity, Pulsatility index (PI), resistance index (RI), and systole/diastole (S/D) were measured for all arteries.
UNASSIGNED: The donors of the case group had a lower mean MCA S/D (4.48 ± 1.89) than the control group (6.48 ± 1.97) (P = 0.01) and higher mean umbilical parameters, including PI, RI, and S/D (P < 0.05). The recipients of the case group had a lower mean renal PI than the control (P = 0.008) and lower mean MCA PI, RI, and S/D (P < 0.05). The donor group had a higher mean umbilical RI and S/D than the recipient twin, while the mean fetal weight of the recipient group was higher (P < 0.05).
UNASSIGNED: Comparing the RAD parameters between the twins with and without TTTS in the present study did not identify significant results, which rejected the primary hypothesis. Among all RAD parameters, the only significant difference observed in the present study was the lower RAD PI in RT, which cannot suggest this measurement as a valuable tool for the prediction of TTTS in MCDA twins. Therefore, the results of the present study failed to show the additional value of RAD, compared with the conventional Doppler examination of fetal arteries. Further studies are required to prove this conclusion.