脐动脉血流异常的单绒毛膜和双绒毛膜双胎的临床研究

目的探讨脐动脉血流异常的单绒毛膜双胎和双绒毛膜双胎母体并发症、胎儿附属物及围生儿并发症的差异和临床处理。方法选取2010年1月至2014年12月脐动脉血流异常的48例双胎进行回顾性分析，其中单绒毛膜双胎（单绒组）18例，双绒毛膜双胎（双绒组）30例，比较两组母体并发症、胎儿附属物异常、双胎生长不一致、脐动脉舒张末期血流缺失及围生儿结局的差异。结果单绒组脐带异常、胎盘异常、胎盘病理异常、双胎生长不一致、脐动脉舒张末期血流缺失、小于胎龄儿、新生儿窒息、新生儿畸形、围生儿死亡发生率明显高于双绒组，差异均有统计学意义（P〈0．05）。两组母体并发症、羊水量异常发生率差异无统计学意义（P〉0．05）。结论脐动脉血流异常对双胎妊娠结局不利，尤其对单绒毛膜双胎妊娠结局影响更大，故应及早判断双胎绒毛膜性质，及时行脐动脉血流监测，加强监护及干预，改善围生儿结局。

Objective To analyse the maternal complications, fetal appendage and periaatal complications of monochorionic and dichorionic twin pregnancy with abnormal umbilical artery blood and clinical management. Methods A retrospective analysis of 48 twin pregnancies with abnormal umbilical artery blood in Ningbo Women ＆ Children＇s Hospital from January 2010 to December 2014 was conducted, 18 cases were monochorionic twin pregnancies （ monochorionic group ） , the other 30 cases were dichorionic twin pregnancies （ dichorionic group ） . The maternal complications, fetal appendage, twin growth discordance, absent end-diastolic velocity and perinatal outcomes were compared between the two groups.Results The incidences of abnormal umbilical cord, abnormal placenta, abnormal pathologic placenta, twin weight discordance, absent end-diastolic velocity, small for gestation age, neonatal asphyxia, neonatal deformity and perinatal mortality in monochorionic group were significantly higher than those in dichorionic group, significant differences were found （P〈0.05） . There were no statistically differences in maternal complications and abnormal amniotic fluid volume between the two groups （P〉0.05） . Conclusion Abnormal umbilical artery blood was detrimental to the outcomes of twin pregnancy, especially to the monochorionic twin pregnancy. Differentiation between monochorionic and dichorionic twin pregnancy in first trimester of pregnancy by ultrasonography is needed. The timely monitoring of umbilical arterial blood flow is also necessary. It is crucial to improve perinatal outcomes by strengthening the prenatal care and intervention.