Značaj parametara ultrazvučne biometrije za predviđanje ishoda monohorionskih blizanačkih trudnoća

Abstract

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 pregleda 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...