The impact of chorionicity on maternal pregnancy outcomes
The impact of chorionicity on maternal pregnancy outcomes
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DOI：
10.1016/j.ajog.2015.05.027
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发表时间：
2015-09-01
影响因子：
9.8
通讯作者：
Cahill, Alison G.
中科院分区：
文献类型：
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作者：
Carter, Ebony B.;Bishop, Katherine C.;Cahill, Alison G.
目的：携带双胞胎妊娠的妇女经常接受类似的咨询，无论绒毛膜，与双胞胎输血综合征（TTTS）的显着例外;然而，很少有人知道是否存在1对2胎盘赋予不同的孕产妇风险。研究设计：这是一项回顾性队列研究，所有双胞胎妊娠在我们的机构进行常规中期妊娠超声解剖调查，从1990年到2010年。次要结局包括其他不良孕产妇和新生儿结局。计算相对风险和调整后的比值比（aOR）。结果：2301例妊娠中，绒毛膜双胎妊娠1747例（75.9%），单绒毛膜双胎妊娠554例（24.1%）。先兆子痫、妊娠期糖尿病、胎盘早剥、前置胎盘、早产和早产胎膜早破（PPROM）的发生率在绒毛膜妊娠与单绒毛膜妊娠中无显著差异。单绒毛膜双胞胎中早产小于34周（aOR，1.47; 95%置信区间[CI]，1.17-1.86）和小于28周（aOR，2.58; 95% CI，1.58-4.20）的可能性更大，新生儿重症监护病房入院的可能性也更大（aOR，1.41; 95% CI，1.12-1.78）。单绒毛膜双胎的平均胎龄为34.2周，而绒毛膜双胎的平均胎龄为35.0周（P <0.001）。单绒毛膜双胞胎的住院时间显著延长，平均为13.7天，而双绒毛膜双胞胎为10.8天（P = 0.01）。结论：根据绒毛膜情况，产妇结局无显著差异;然而，单绒毛膜情况与胎儿风险增加相关。这些信息可能有助于指导双胞胎的准父母进行更有针对性的咨询，尽管额外胎盘的存在不会带来额外的母亲风险，但单绒毛膜婴儿往往会更早分娩，需要更长的住院时间。
OBJECTIVE: Women carrying twin pregnancies often receive similar counseling, regardless of chorionicity, with the notable exception of twin-twin transfusion syndrome (TTTS); however, little is known about whether the presence of 1 vs 2 placentas confers dissimilar maternal risks. We sought to determine differences in maternal and neonatal outcomes based on chorionicity.STUDY DESIGN: This was a retrospective cohort study of all twin pregnancies at our institution undergoing routine second-trimester ultrasound for anatomic survey from 1990 through 2010. Secondary outcomes included other adverse maternal and neonatal outcomes. Relative risks and adjusted odds ratios (aORs) were calculated. Cluster analysis was used to account for nonindependence of twin pairs.RESULTS: Of 2301 pregnancies, 1747 (75.9%) were dichorionic and 554 (24.1%) were monochorionic. Rates of preeclampsia, gestational diabetes, placental abruption, placenta previa, preterm labor, and preterm premature rupture of membranes (PPROM) were not significantly different in dichorionic vs monochorionic pregnancies. Early preterm delivery less than 34 weeks (aOR, 1.47; 95% confidence interval [CI], 1.17-1.86) and less than 28 weeks (aOR, 2.58; 95% CI, 1.58-4.20) were more likely in monochorionic twins, as was neonatal intensive care unit admission (aOR, 1.41; 95% CI, 1.12-1.78). Monochorionic twins delivered earlier at a mean gestational age of 34.2 weeks vs 35.0 weeks for dichorionic twins (P < .001). Hospital length of stay was significantly longer for monochorionic twins with a mean of 13.7 days vs 10.8 days for dichorionic twins (P = .01).CONCLUSION: There are no significant differences in maternal outcomes by chorionicity; however, monochorionicity is associated with increased fetal risks. This information may be helpful in guiding more targeted counseling to expectant parents of twins that, although the presence of an additional placenta does not confer additional maternal risks, monochorionic infants tend to deliver earlier and require longer hospital stays.