病理性双胎妊娠的超声诊断

Ultrasonographic diagnosis of pathological twin pregnancy

目的探讨腹部超声在胎儿畸形尤其是病理性双胎妊娠中的诊断价值。方法近两年产前超声检查9 982例,孕早期超声检查要注意观察绒毛膜囊数及羊膜囊数,孕中晚期注意观察胎盘数、双胎儿大小、形态、羊水量及脐血流的变化。结果9 982例产前超声检查中单胎妊娠9 831例,单胎畸形458例,占妊娠总数的4.59%,占单胎妊娠的4.66%;双胎妊娠150例,病理性双胎32例,占妊娠总数的0.32%,占双胎的21.33%;三胎妊娠1例,占妊娠总数的0.01%。双胎病理性妊娠包括:①双胎之一消失或形成纸样儿17例,占病理性双胎的53.13%;②双胎宫内生长受限7例,占21.88%;③双胎输血综合征5例,占15.63%;④双胎之一无心畸形1例,占3.13%;⑤联体双胎2例,占6.25%。结论腹部彩色多普勒超声检查是筛查胎儿畸形及病理性双胎妊娠的最佳选择,简便、易行、无创、重复性好。

Objective To evaluate value of abdominal ultrasonography in diagnosis of fetal malformation especially in pathological twin pregnancy. Methods 9 982 prenatal ultrasonographic examinations were performed over a two-year period. For early pregnancy, numbers of chorionic sac and amniotic sac were observed and for middle and late pregnancy, number of placenta, size and shape of the twins, volume of amniotic fluid, and changes in blood flow in umbilical cord were examined, Results 9 831 singleton pregnancies were identified, of which 458 malformed singletons were found, accounting for 4.66% of singleton pregnancies and 4.59% of all pregnancies, 150 twin pregnancies were identified, of which 32 malformed twins were found, accounting for 21, 33% of twin pregnancies and O. 32% of all pregnancies, One triple pregnancy was identified, accounting for 0. 01% of all pregnancies. Pathological twin pregnancies included： （1） vanished one of twins or fetus papyraceous （ 17 cases, accounting for 53. 13% of pathological twin pregnancies ） ; （2） twin fetal intrauterine growth retardation（IUGR） （7 cases, 21, 88%）; （3） twin to twin transfusion syndrome （5 cases, 15.63%）; （4） twin pregnancy with one acardiac fetus （ 1 case, 3.13% ） ; （5） conjoined twins （2 cases, 6.25% ）. Conclusion As a simple and convenient non-invasive method with good repeativity, abdominal color Doppler ultrasonography is the best option for screening fetal malformation and pathological twin pregnancy.