双胎妊娠的胎儿生长评估:单胎与双胎特异性生长图的循证评价。

IF 1.4 4区 医学 Q3 OBSTETRICS & GYNECOLOGY
Eileen Deuster, Hiba J Mustafa, Eileen M O'Conner McFerran, Asma Khalil
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引用次数: 0

摘要

近几十年来,双胎妊娠的流行病学发生了很大的变化。自1980年以来,美国的双胞胎出生率增加了76%,主要是由于辅助生殖技术(ART)的广泛使用。这一人口变化重塑了双胎妊娠自然史的临床观点和证据,强调了其独特的风险和管理需求。与单胎妊娠相比,双胎妊娠的不良后果风险明显更高。围产期死亡率估计为16.0至17.3‰,胎儿生长受限是一个主要原因。选择性胎儿生长受限(sFGR)并发症发生率分别高达10%的双绒毛膜和15%的单绒毛膜双胎妊娠。因此,准确和及时的生长评估对这些妊娠的监测策略和临床决策至关重要。然而,评估双胞胎的成长面临着独特的挑战。与单纯性的生理差异使得单纯性的标准不充分,常常导致病理诊断过度或不足。有证据支持使用双特异性生长图,特别是按时间顺序分层的生长图,这可能提高预后准确性并减少不必要的干预。其他考虑因素包括双生子间不一致、sFGR和不断发展的分期系统,如Gratacós和修改的分类。本综述的目的是严格审查目前的方法胎儿生长评估双胎妊娠。我们总结了应用单例标准的局限性,评估了支持双特异性参考文献的证据,并探讨了时序性、纵向评估和多普勒研究如何改进诊断和管理。最后,我们强调了持续的争议,实践中的国际差异,以及进一步验证诊断阈值的必要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Fetal Growth Assessment in Twin Pregnancies: Evidence-Based Evaluation of Singleton Versus Twin-Specific Growth Charts.

The epidemiology of twin pregnancies has shifted considerably over recent decades. Since 1980, the twin birth rate in the United States has increased by 76%, largely driven by the widespread use of assisted reproductive technologies (ART). This demographic change has reshaped clinical perspectives and evidence on the natural history of twin gestations, underscoring their unique risks and management needs. Twin pregnancies remain associated with a markedly higher risk of adverse outcomes compared with singletons. The perinatal mortality rate is estimated at 16.0 to 17.3 per 1000 births, with fetal growth restriction representing a major contributor. Selective fetal growth restriction (sFGR) complicates up to 10% of dichorionic and 15% of monochorionic twin pregnancies, respectively. Accurate and timely growth assessment is therefore central to surveillance strategies and clinical decision-making in these pregnancies. However, assessing growth in twins presents distinctive challenges. Physiological differences from singletons render singleton-based standards inadequate, often leading to over- or underdiagnosis of pathology. Evidence supports the use of twin-specific growth charts, particularly those stratified by chorionicity, which may improve prognostic accuracy and reduce unnecessary intervention. Additional considerations include intertwin discordance, sFGR, and evolving staging systems such as the Gratacós and modified classifications. The purpose of this review is to critically examine current approaches to fetal growth assessment in twin pregnancies. We summarize the limitations of applying singleton standards, evaluate the evidence supporting twin-specific references, and explore how chorionicity, longitudinal assessment, and Doppler studies can refine diagnosis and management. Finally, we highlight ongoing controversies, international variation in practice, and the need for further validation of diagnostic thresholds.

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来源期刊
CiteScore
2.70
自引率
0.00%
发文量
186
审稿时长
3 months
期刊介绍: Each issue of Clinical Obstetrics and Gynecology is a complete symposium on one or two timely topics of interest in obstetrics and gynecology. For each quarterly issue, two prominent guest editors solicit contributions on key clinical topics of interest to practicing physicians. Procedures, current clinical problems, medical and surgical treatments, and effective diagnostic aids are all carefully reviewed in original articles. The result is an instructive resource that dispenses trustworthy clinical guidance that enhances your understanding of key areas of your practice.
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