The Clinical Analysis Of Fetal Umbilical Arterial Blood Flow Waveform And Pregnancy Outcomes In Monochorionic Diamniotic Twin Pregnancy

Object:The aim of this study is to explore the initial relationship among fetal umbilical arterial blood flow waveform,clinical complications and pregnancy outcomes in monochorionic diamniotic twin pregnancy(MCDA).During this time,the feature of umbilical artery blood flow changes in MCDA pregnancy coupled with different complications was characterized,and the relationship between umbilical artery blood flow of two fetuses and clinical pregnancy outcome was summarized at the same time.All of the above data could be used for predicting complications during pregnancy and their outcomes,and this provided a clinical basis for further rational pregnancy management.Methods:The data of 151 cases of MCDA pregnant women,prenatally examined and hospitalized in the First Affiliated Hospital of Jinan University(referred to as our hospital)from January 2010 to December 2018 were collected and analyzed.According to whether there are complications,they were classified into six main groups,including non-complicated group,twin-twin transfusion syndrome(TTTS),selective intrauterine growth restriction(s IUGR),gestational diabetes group(GDM),premature rupture of membranes group(PROM)and preeclampsia group(PE).Among them,the complication group was set as the model group and the non-complication group.The umbilical arterial blood flow parameters of the above group and ultrasound examination data during pregnancy were comparatively analyzed.In consideration of different index,the data of pregnancy and their babies was analyzed,including twin birth weight,weight difference between twin birth,twin birth length,twin birth head circumference,1min Apgar score after birth,umbilical artery resistance index(RI),umbilical artery pulsation index(PI)and umbilical artery systolic/diastolic(S/D).Meanwhile,the relationship between the dynamic changes of umbilical artery blood flow parameters and pregnancy outcomes in groups coupled with different complications,such as TTTS and s IUGR in MCDA pregnancy,were profiled and their initial relationship was summarized.Analyzing the difference of pregnancy outcome between two fetuses of MCDA delivered after 32 weeks of gestation and the difference of umbilical artery blood flow parameters between twins during the last ultrasound examination during pregnancy,the correlation between umbilical artery blood flow spectrum difference and pregnancy outcome between two fetuses of MCDA were summarized.Moreover,the basis for prenatal counseling and clinical treatment was provided in the meantime.1.Data collectionMaternal and neonatal data were collected,including age,number of pregnancies,number of deliveries,gestational weeks,mode of delivery,obstetric complications,twin birth weight,difference of twin birth weight,twin birth body length,twin birth head circumference,1min Apgar score after birth,umbilical artery blood flow resistance index(RI),umbilical artery blood,flow pulsation index(PI)and umbilical artery systolic/diastolic(S/D).2.Group settingTwin-twin transfusion syndrome(TTTS),selective intrauterine growth restriction(s IUGR),and gestational diabetes group(GDM),premature rupture of membranes group(PROM),preeclampsia group(PE)were classified into model groups and the non-complication group into control group,respectively.3.Data analysisThe collected data were statistically analyzed using SPSS 24.0 software,and the count data were analyzed by?~2test.Measurement data are expressed as mean±standard deviation(SD)and analyzed by t test.P value less than 0.05 shown significance.Results:1.MCDA pregnancy combined with complications of TTTS and s IUGR were closely related to the early gestational weeks of delivery.The smaller the gestational weeks of delivery,the lower the birth weight,body length and head circumference of twins were observed in the above groups as compared to the control group.A combination of TTTS could result in lower1min Apgar scores after birth in newborns by comparison with control groups.2.Decreased the birth weight,body length,head circumference and??1min Apgar score of twins were found in MCDA pregnancy combined with PROM3.There were no significant difference changes in MCDA pregnant women with GDM,PE as compared to those without complications.4.The mean RI,PI and S/D values of umbilical artery in pregnant women with MCDA were decreased with the progress of gestational weeks.5.There was a difference in umbilical arterial blood flow between MCDA with different complications and without complications,which occurred at different times.MCDA with TTTS or PE occurred before 26 weeks of gestation.MCDA with GDM occurred during 26 and 29weeks of gestation,and MCDA with s IUGR before 33 weeks of gestation,respectively.There was no significant difference in umbilical artery blood flow between PROM group and the non-complication group.6.The difference in RI and PI of umbilical artery,the difference between two fetuses of MCDA in late pregnancy is closely related to the difference of pregnancy outcome between two fetuses.It can be used as an index to predict pregnancy outcome,but the index of S/D of umbilical artery is lacking of evidence for predicting pregnancy outcome.