背景:脊髓插入(VCI)和边缘脊髓插入(MCI)是单胎妊娠不良围产期结局的众所周知的危险因素。然而,尚未对双胎妊娠中VCI或MCI与围产期结局之间的潜在联系进行系统评估.本研究旨在探讨双胎妊娠中VCI或MCI与围产期结局的关系。
方法:这项回顾性单中心队列研究包括在西南三级医院分娩的双胎妊娠妇女,2017年1月至2022年12月期间的中国。通过腹部超声鉴定VCI和MCI,并在胎盘分娩后确认。Logistic回归,使用多项logit回归和广义估计方程模型来评估VCI或MCI与围产期结局之间的关联。
结果:共纳入3682例双胎妊娠,包括100例(2.7%)VCI妊娠和149例(4.0%)MCI妊娠。与正常脐带插入的怀孕相比,单绒毛膜和双绒毛膜妊娠合并VCI均与32-34周早产风险增加相关(aRRR2.94,95%CI1.03-8.39;aRRR2.55,95%CI1.19-5.46),而MCI妊娠与早产无关。VCI与单绒毛膜妊娠中前置胎盘(aOR6.36,95%CI1.92-21.04)和双绒毛膜妊娠中胎盘植入(aOR1.85,95%CI1.06-3.23)的发生率较高相关。MCI与先兆子痫风险增加相关(aOR3.07,95%CI1.49-6.32),单绒毛膜妊娠和胎龄小于胎龄新生儿(aOR1.97,95%CI1.24-3.14)双胎出生体重不一致≥20%(aOR2.40,95%CI1.08-5.60)和选择性胎儿生长受限(aOR2.46,95%CI1.08-5.60).
结论:VCI与双胎妊娠的早产风险增加相关,而与绒毛膜无关。而MCI与先兆子痫风险增加有关,单绒毛膜妊娠和双胎胎龄小于胎龄新生儿的双胎出生体重不一致。
BACKGROUND: Velamentous cord insertion (VCI) and marginal cord insertion (MCI) are well-known risk factors for adverse perinatal outcomes in singleton pregnancies. However, the potential links between VCI or MCI and perinatal outcomes in twin pregnancies have yet to be systematically evaluated. This study aimed to investigate the relationships between VCI or MCI and perinatal outcomes in twin pregnancies.
METHODS: This retrospective single-center cohort study included women with twin pregnancies who gave birth in a tertiary hospital in Southwest, China between January 2017 and December 2022. VCI and MCI were identified by abdominal ultrasound and confirmed after placental delivery. Logistic regression, multinomial logit regression and generalized estimation equation models were used to evaluate the association between VCI or MCI and perinatal outcomes.
RESULTS: A total of 3682 twin pregnancies were included, including 100 (2.7%) pregnancies with VCI and 149 (4.0%) pregnancies with MCI. Compared to pregnancies with normal cord insertion, both monochorionic and dichorionic pregnancies with VCI were associated with an increased risk of preterm delivery 32-34 weeks (aRRR 2.94, 95% CI 1.03-8.39; aRRR 2.55, 95% CI 1.19-5.46, respectively), while pregnancies with MCI were not associated with preterm delivery. VCI was associated with a higher incidence of placental previa (aOR 6.36, 95% CI 1.92-21.04) in monochorionic pregnancies and placental accreta (aOR 1.85, 95% CI 1.06-3.23) in dichorionic pregnancies. MCI was associated with an increased risk of preeclampsia (aOR 3.07, 95% CI 1.49-6.32), intertwin birthweight discordance ≥ 20% (aOR 2.40, 95% CI 1.08-5.60) and selective fetal growth restriction (aOR 2.46, 95% CI 1.08-5.60) in monochorionic pregnancies and small-for-gestational age neonates (aOR 1.97, 95% CI 1.24-3.14) in dichorionic pregnancies.
CONCLUSIONS: VCI was associated with an increased risk of preterm delivery in twin pregnancies irrespective of chorionicity, whereas MCI was associated with an increased preeclampsia risk, significant intertwin birthweight discordance in monochorionic pregnancies and small-for-gestational age neonates in dichorionic pregnancies.