Twin chorionicity and the risk of stillbirth
Twin chorionicity and the risk of stillbirth
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DOI：
10.1097/aog.0b013e318160d65d
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发表时间：
2008-02-01
影响因子：
7.2
通讯作者：
D'Alton, Mary E.
中科院分区：
文献类型：
--
作者：
Lee, Young Mi;Wylie, Blair J.;D'Alton, Mary E.
目的：为了估计绒毛膜对双胞胎死胎风险的影响，从2000年12月至2007年5月，在一个三级保健中心进行了一项回顾性队列分析，所有双胞胎分娩的妊娠至少24周。计算了单绒毛膜双羊膜腔双胎和双绒毛膜双羊膜腔双胎的妊娠进展时胎儿死亡的风险。使用Kaplan-Meier分析比较子宫内总体生存率，并估计风险比和95%置信区间，以评估差异程度。受生长异常，异常，或双胞胎输血综合征的影响，随后被排除和绒毛膜的生存类似比较这些“明显正常”gestations.Results：数据从1,000个连续双胞胎对（196 monochorionic双胞胎和804 monochorionic双胞胎）进行了分析。死胎发生在7（3.6%）monochorionic-diamniotic和9（1.1%）monochorionic-diamniotic双胞胎对。单绒毛膜双羊膜腔双胎的死胎风险高于双绒毛膜双羊膜腔双胎，（对数秩P= 0.004）和24周后的每个胎龄，这种风险在771（130例单绒毛膜双羊膜腔双胎和641例双绒毛膜双羊膜腔双胎）“明显正常”双胎结论：单绒毛膜对双胞胎的宫内存活率有负面影响，即使是在没有异常的单绒毛膜双胞胎中。
OBJECTIVE: To estimate the effect of chorionicity on the risk of stillbirth in twins.METHODS: A retrospective cohort analysis was performed of all twin deliveries of at least 24 weeks of gestation at a single tertiary care center from December 2000 to May 2007. The risk of fetal death with advancing gestation was calculated for monochorionic-diamniotic twins and for dichorionic-diamniotic twins. Overall in utero survival was compared by using Kaplan-Meier analysis and a hazards ratio with 95% confidence intervals estimated to assess the degree of difference. Pregnancies affected by growth abnormalities, anomalies, or twin-twin transfusion syndrome were subsequently excluded and survival by chorionicity similarly compared within these "apparently normal" gestations.RESULTS: Data from 1,000 consecutive twin pairs (196 monochorionic-diamniotic twins and 804 dichorionic-diamniotic twins) were analyzed. Stillbirths occurred in seven (3.6%) monochorionic-diamniotic and nine (1.1%) dichorionic-diamniotic twin pairs. Monochorionic-diamniotic twins had a higher risk of stillbirth compared with dichorionic-diamniotic twins, both overall (log-rank P=.004) and at each gestational age after 24 weeks, with this risk persisting in the subset of 771 (130 monochorionic-diamniotic twins and 641 dichorionic-diamniotic twins) "apparently normal" twins (log-rank P=.039).CONCLUSION: Monochorionicity has a negative effect on the in utero survival of twins, even among monochorionic-diamniotic twins without abnormalities.