早期超声筛查不同绒毛膜性双胎妊娠及胎儿畸形的价值

Ultrasound screening at 11～13^(+6) weeks in monochorionic and dichorionic twin pregnancies

目的探讨妊娠11～13+6周超声筛查不同绒毛膜性双胎妊娠的价值。方法统计2007年1月至2009年10月在中山大学附属第一医院接受妊娠11～13+6周产前常规超声筛查病例,比较不同绒毛膜性双胎胎儿畸形的种类构成及检出率,及其与单胎妊娠的差异。结果接受妊娠11～13+6周产前常规超声检查共2578例,其中双胎妊娠155例,占6.0%,包括单绒毛膜囊(MC)双胎妊娠30例,双绒毛膜囊(DC)双胎妊娠125例。MC双胎与DC双胎胎儿畸形检出率分别为43.3%和8.8%,同期单胎妊娠胎儿畸形检出率为2.2%;MC双胎胎儿畸形的种类以脐动脉返流胎和联体双胎为多,DC双胎胎儿畸形以一胎发育异常为主,其畸形种类与单胎畸形种类相似。结论妊娠11～13+6周胎儿超声检查对于早期诊断双胎妊娠、判断绒毛膜性及尽早发现胎儿畸形,指导正确的孕期处理具有重要的临床意义。

Objective To assess the value of ultrasound screening at 11 - 13^ ＋6 weeks in twins. Methods Cases included the pregnancy women who received prenatal ultrasound examination at 11 - 13 ^＋6 weeks between Jan. 2007 and Oct. 2009 in the First Affiliated Hospital of Sun Yat-sen University. The detection rate and constitute of fetal structural abnormalities in monochorionie （MC） twins, diehorionic （DC） twins and singletons were compared. Results Prenatal uhrasound examination were performed in 2578 pregnancies at 11 -13 ^＋6 weeks, including 155 （6. 0% ） cases of twin pregnancies （30 MC twins and 125 DC twins）. The detection rate of fetal structural abnormalities in MC twins, DC twins and singletons were 43.3%, 8.8% and 2. 2%, respectively. The differences of the structural abnormalities detection rate were statistically significant among the groups. Conjoined twins and twin reversed arterial peffusion sequence were the most common malformations in MC twins, while the abnormalities in one fetus of DC twins constituted the mainly malformations and the constitute ratios was almost the same as which in singletons. Conclusion The ultrasound screening in twins at 11 -13 ^＋6 weeks plays an important role in diagnosing twins and the chofioncity, detecting fetal structural abnormalities, which is valuable for the prenatal surveillance and consulting.