Značaj parametara ultrazvučne biometrije za predviđanje ishoda monohorionskih blizanačkih trudnoća
First trimester ultrasonographic parameters in prediction of the course and outcome of monochorionic twin pregnancies.
Doktorand
Akšam, Slavica S.Mentor
Plešinac, SnežanaČlanovi komisije
Plećaš, DarkoKontić-Vučinić, Olivera
Dimitrijević, Aleksandra
Metapodaci
Prikaz svih podataka o disertacijiSažetak
Prema sadašnjim stavovima i preporukama, ultrasonografska fetalna
merenja u prvom i drugom trimestru imaju najveću moć za predikciju daljih
komplikacija kao i samih ishoda monohorionskih trudnoća, ali su rezultati prethodnih
studija nekonzistentni ili nedovoljno pouzdani zbog male incidence monohorionskih
blizanaca, pa su dalja istraživanja na ovu temu još uvek potrebna.
Cilj: Ciljevi studije su bili analizirati tok i ishod monohorionskih blizanačkih
trudnoća, a zatim ispitati povezanost i potencijalnu prediktivnu vrednost
ultrasonografskih parametara koji se određuju u prvom i drugom trimestru trudnoće na
tok i ishod monohorionskih blizanačkih trudnoća.
Materijal i metod: Sprovedena je prospektivna kohortna studija svih trudnica sa
monohorionskim blizanačkim trudnoćama koje su kontrolisane i porođene u Klinici za
ginekologiju i akušerstvo Kliničkog centra Srbije u Beogradu, u periodu od 01. januara
2010. godine do 31. decembra 2015. godine. Svakoj pacijentkinji je već tokom prvog
preg...leda uzeta kompletna anamneza sa podacima o godinama života, komorbiditetima,
paritetu, kao i načinu nastanka trudnoće. U prvom trimestru, između 11 i 14 nedelje
trudnoće za svakog blizanca su ultrazvučno izmereni dužina teme-trtica (crown-rump
lenght CRL) i debljina nuhalne translucence (NT). U periodu od 16 do 18 nedelje
trudnoće, ultrazvučnim pregledom za oba blizanca, određeni su biometrijski parametri:
biparijetalni dijametar (biparietal diameter BPD), obim trbuha (abdominal
circumference AC) i dužina butne kosti (femur length FL). Redovno su registrovane sve
komplikacije trudnoće. Naročita pažnja se obraćala na pojavu intrauterinog zastoja u
rastu jednog ili oba blizanca (intrauterine growth restriction IUGR), interblizanačkog
transfuzionog sindroma (twin-to-twin transfusion syndrome TTTS), spontanog pobačaja
(pre 24. nedelje gestacije) ili prevremenog porođaja (pre 35. nedelje gestacije) i smrti
jednog ili oba blizanca...
According to current positions and recommendations,
ultrasonographic fetal measurements in the first and second trimesters have the greatest
power to predict further complications as well as the outcomes of monochorionic
pregnancies, but the results of previous studies are inconsistent or insufficiently reliable
due to the small incidence of monochorion twins, so further research on this matter is
always necessary.
Objective: The aims of the study were to analyze the course and outcome of
monochorionic twin pregnancies, and then examine the connection and potential
predictive value of ultrasonographic parameters that are assessed in the first and second
trimester of pregnancy on the cource and outcome of monochorion twin pregnancies.
Material and Method: We conducted a prospective cohort study of all pregnant
women with monochorionic twin pregnancies checked-up and delivered at the Clinic for
Gynecology and Obstetrics Clinical Center of Serbia in Belgrade, in the period from
January 1,... 2010 to December 31.2015. Already during the first examination, a complete
history was taken from every patient with data on age, comorbidity, parity, and the way
of pregnancy commencement. In the first trimester, between 11 and 14 weeks of
pregnancy for each twin, the crown-rump lenght (CRL) and the thickness of nuchal
translucency (NT) were measured ultrasonically. In the period from 16 to 18 weeks of
pregnancy, ultrasound examination for both twins determined biometric parameters:
biparietal diameter (BPD), abdominal circumference (AC) and femur length (FL). All
complications of pregnancy were registered regularly. Particular attention was paid to
the occurrence of intrauterine growth restriction (IUGR) in one or both twins, twin-totwin
transfusion syndrome (TTTS), spontaneous abortion (before 24 weeks of gestation)
or premature labor (before 35 weeks of gestation) and the death of one or both twins...