产前超声监测对双胎妊娠并发症的诊断及治疗选择的价值

The Value of Prenatal Ultrasound Monitoring in the Diagnosis and Management of Twins Pregnancy Complications

目的探讨双胎妊娠的产前超声监测方法对双胎并发症的诊断及治疗选择的价值。方法回顾性分析81例双胎妊娠孕妇的临床资料和超声监测方法,综合评估是否出现双胎输血综合征(TTTS)、选择性胎儿生长受限(sIUGR)等单绒毛膜双胎(MC双胎)特有的并发症,进行相应分期、分型和监测;随访至妊娠终止。结果81例双胎妊娠中双绒毛膜双羊膜囊双胎(DCDA)40例出现双胎之一宫内死亡1例,双胎生长不一致1例;38例单绒毛膜双羊膜囊双胎(MCDA)出现TTTS 4例,sIUGR 2例,双胎之一唇腭裂畸形1例,双胎之一宫内死亡1例;3例单绒毛膜单羊膜囊双胎(MCMA)并发双胎之一无心畸形1例,联体双胎1例。DCDA并发症明显小于MC双胎并发症(P<0.05)。DCDA双胎丢失率1/80(胎),MC双胎丢失率11/82(胎)。DCDA胎儿丢失率明显低于MC双胎胎儿丢失率(P<0.05)。产前超声监测与终止妊娠结果100%符合。结论早孕期诊断双胎妊娠的绒毛膜性具有重要的临床意义;对<26孕周的MC双胎每2周监测1次,可早期诊断并发症;对≥26孕周的TTTS及sIUGR在超声严密监测下选择分娩时机,可提高MC双胎围生儿生存率。

Objective To explore the value of prenatal ultrasound monitoring in the diagnosis and the treatment of the twin pregnancy complications . Methods The clinical data and ultrasound follow up medical files of 81 pregnant women with twin pregnancies were retrospectively analyzed during the study period （March 2011~ April 2014） . Twin to twin transfusion syndrome （TTTS） and selective intra-uterine growth restriction（sIUGR） and other complications were comprehensively assessed ,classified and moni-tored . All the cases were followed-up until pregnancy has been terminated . Results Among 81 cases of twins pregnancy ,forty cases were dichorionic-diamniotic twins pregnancies （DCDA） in which one had in-trauterine fetal death and one had disproportional grow th ;thirty-eight cases were monochorionic twins （MCDA） in which 4 developed TTTS ,two sIUGR ,one cleft lip in one of twins ,one intrauterine death in one of the twins ;Three cases were mono-chorionic-mono-amniotic twin （MCMA） in which one was com-plicated with acardia in one of the twins and one with conjoined twins . DC twins complications are much smaller than the MC twins complications （P〈0 .05） . The proportion of twins loss was 1/80 in DCDA and 11/82 in MC twins . DC twins fetal loss rate was significantly lower than MC twins fetal loss rate （P〈0 .05） . Prenatal ultrasound monitoring was completely coincident with pregnancy termination re-sults . Conclusion Early prenatal diagnosis of twin pregnancy chorionicity has important clinical signifi-cance . Prenatal ultrasound monitoring once two weeks can early detect complications in MC twins at less than 26 gestational weeks . Determination of the time of divery in MC twins complicated by TTTS or sIUGR over 26 gestational weeks ,the use by prenatal ultrasound monitoring could improve perinatal sur-vival rate .