Analysis of natural pregnancy outcome of pump twin after spontaneous cessation of blood flow in the umbilical artery of the acardiac twin with reverse arterial perfusion sequence
10.3760/cma.j.cn131148-20240723-00402
- VernacularTitle:双胎反向动脉灌注序列征血流自然阻断后泵血儿自然妊娠结局分析
- Author:
Renfeng YI
1
;
Li LU
1
;
Chen CHENG
1
;
Sheng ZHAO
1
;
Xiaohong YANG
1
Author Information
1. 湖北省妇幼保健院超声影像科，武汉430070
- Publication Type:Journal Article
- Keywords:
Ultrasonography，prenatal;
Twin reverse perfusion sequence;
Spontaneous cessation of blood flow in acardia twin
- From:
Chinese Journal of Ultrasonography
2025;34(1):74-78
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the relationship between the growth and development of pump twin and the changes of blood flow parameters and the natural pregnancy outcome of pump twin after pontaneous cessation of blood flow in the umbilical artery of the acardiac twin with reverse arterial perfusion sequence（TRAPs）detected by prenatal ultrasound.Methods:From January 2001 to August 2023，a total of 23 cases of TRAPs diagnosed in Hubei Maternal and Child Health Hospital were retrospectively collected and detected by ultrasound follow-up. According to the pregnancy outcome of the pump twin，23 patients were divided into the poor pregnancy outcome group（6 cases）and the good pregnancy outcome group（17 cases）. The changes of ultrasound growth indexes and blood flow parameters of the pump twin and acardia twin were compared between the two groups. The hemodynamic parameters with statistically significant differences between the two groups were selected，and the diagnostic efficacy for TRAPs pregnancy outcomes was analyzed using ROC analysis.Results:There were no statistically significant differences in the structural development of acardiac fetus between the two groups，including skin edema，hemicardia，skull structure，trunk structure，upper and lower limbs，cardiothoracic ratio，amniotic fluid，sex and amniotic nature of twins（all P > 0.05）. The lower limbs of acardia twin was significantly higher in the poor pregnancy outcome group（6/6）than in the good pregnancy outcome group（7/17），and the difference was statistically significant（ P < 0.05）. The relevant parameters of ultrasound blood flow were shown in both groups，there were no significant differences in middle cerebral artery pulsation index（PI）and umbilical artery PI between the two groups before natural occlusion of fetal blood flow with TRAPs（all P > 0.05）. In the good pregnancy outcome group，the ratio of umbilical cord diameter between pump twin and acardia twin was higher than that in the poor pregnancy outcome group，the difference was statistically significant（ P < 0.05）. The scatter plot of the ratio of umbilical diameter between the two groups was drawn，and the cut-off value was 2.125 through ROC curve analysis，the area under the curve（AUC）was 0.961，the sensitivity was 94.10%，the specificity was 100%，and the Yoden index was 0.94. Conclusions:The ratio of umbilical cord diameter between pump twin and acardia twin in TRAPs is significant for predicting the pregnancy outcome of pump twin.
