正常双胎妊娠孕妇左心结构、功能及子宫动脉血流参数纵向研究

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Abstract Objective: To longitudinally investigate maternal left cardiac morphology, function and uterine artery resistances in uncomplicated twin gestations. Methods: Women with twin pregnancies, who were examined and delivered in Beijing Obstetrics and Gynecology Hospital between January 2013 to October 2014, were enrolled prospectively and underwent serial fetal ultrasound examination and maternal echocardiography at 11~14 weeks, 21~26 weeks and 28~34 weeks of gestation. Those with any complications were excluded. Left cardiac morphology, function and uterine artery resistances were assessed longitudinally and compared with those obtained at the same gestational age periods in a group of singleton gestations. Results: There were 50 normal twin pregnancies and 35 singleton pregnancies as controls. In twin pregnancies, left atrial end-diastolic dimensions, left ventricular end-diastolic and end-systolic dimensions showed significant increase throughout the pregnancy period, especially between 11~14 weeks and 21~26 weeks, but the difference was not statistically significant between twin pregnancies and control group. Total vascular resistance(TVR), cardiac output(CO) and heart rate(HR) changed throughout the pregnancy period, especially between 11~14 weeks and 21~26 weeks. E/E' increased throughout the pregnancy period and grew rapidly between 21~26 weeks and 28~34 weeks. Compared with singletons, HR and CO were significantly higher at 21~26 week and diastolic blood pressure(dBp) was significantly higher at 28~34 weeks in twins. Bilateral uterine artery mean pulse index(PI), resistance index(RI) and ratio of peak-systolic to end-diastolic blood flow velocities(S/D) decreased significantly in twins throughout the pregnancy period. The existence of early-diastolic notch decreased significantly especially between 11~14 weeks and 21~26 weeks. Bilateral uterine artery mean PI, RI and S/D at each period and the existence of early-diastolic notch at 11~14 weeks were significantly lower in twins than in singletons(P<0.05). Conclusions: In twin pregnancies, left cardiac dimensions, CO and HR showed significant increase. TVR and uterine artery resistances decreased throughout the pregnancy period, especially between the first and second trimester. Left ventricular filling pressure was growing fast between the second and third trimester.Compared with singletons, HR and CO were significantly higher at the second trimester, dBp was significantly higher at the third trimester in twins, and uterine artery resistance was lower at each time period. The existence of early-diastolic notch was lower at the first trimester.

Key words： Ventricular function, left Pregnancy, multi Ultrasonography, Doppler, color

Received: 06 May 2015

PACS:	Ｒ714.252
	Ｒ714.23
	R445.1

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	LI Xiao-fei
	WU Qing-qing

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LI Xiao-fei,WU Qing-qing. A longitudinal study of maternal left cardiac morphology, function and uterine artery resistances in#br# normal twin pregnancy[J]. JOURNAL OF CHINA MEDICAL IMAGING, 2016, 27(1): 32-37.

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http://www.jccmi.com.cn/EN/ OR http://www.jccmi.com.cn/EN/Y2016/V27/I1/32

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