提示单绒毛膜双胎选择性生长受限胎儿预后不良的超声征象

Ultrasonographic indicators predicting the outcomes of monochorionic twins with selective fetal growth restriction

目的探讨提示单绒毛膜双胎合并一胎选择性生长受限（selectivefetalgrowthrestriction，sFGR）胎儿宫内死亡或新生儿期死亡的超声征象。方法研究对象为2005年1月至2010年5月在本院行产前超声检查发现的单绒毛膜双胎合并一胎sFGR病例，均采用期待疗法并随访分娩结局。记录以下超声指标：sFGR胎儿脐动脉血流频谱异常、大胎羊水过多、sFGR胎儿羊水过少、双胎估计胎儿体重的差异百分数、脐带帆状附着及诊断孕周。应用Logistic回归分析各超声指标与sFGR胎儿发生死亡的相关性。结果共诊断51例单绒毛膜双胎合并一胎sFGR，其中11例（21．6％）sFGR胎儿死亡，包括4例宫内死亡和7例新生儿期死亡；双胎均死亡3例（5．9％）。Logistic回归分析发现，sFGR胎儿出现羊水过少（OR=22．80，95％CI：3．58～145．31，P=0．001）和脐动脉血流频谱异常（0R=6．51，95％CI：1．16～36．53，P=0．033）是sFGR胎儿宫内死亡或新生儿期死亡的独立危险因素。结论sFGR胎儿脐动脉舒张末期血流频谱异常和羊水过少均提示预后不良。

Objective To investigate the ultrasonographic indicators predicting the outcomes of selective fetal growth restriction （ sFGR ） fetuses in monochorionic twins under expectant management. Methods Monochorionic twins with sFGR diagnosed in the First Affiliated Hospital of SUN Yat sen University from Jan. 2005 to May 2010 were included into this study. All patients underwent expectant treatment. Ultrasound appearances of monochorionic twins were documented in detail when sFGR was diagnosed. At the initial evaluation, presence or absence of the following abnormalities were documented, including abnormal Doppler flow in the umbilical artery, polyhydramnios in the larger twin, oligohydramnios, fetal weight discordance and velamentous cord insertion in sFGR fetuses; gestational age at diagnosis was recorded as well. The relationship between these ultrasound characteristics and mortality of sFGR fetus was analyzed with Logistic regression. Results Of 51 sFGR fetuses, 11 （21.60/00） suffered from fetal death, including four intrauterine demise and seven neonatal death; both twins were dead in 3 cases. Logistic regression analysis demonstrated that oligohydramnios （OR = 22.80, 95 % CI ： 3.58-145.31, P： 0.001 ） and abnormality of diastolic flow in the umbilical artery （OR = 6.51, 95% CI： 1.16-36.53, P = 0.033） were independent risk factors of mortality of sFGR fetuses. Conclusions Both oligohydramnios and abnormal Doppler flow in the umbilical artery suggest poor prognosis of sFGR fetuses in monochorionic twins.