单绒毛膜双胎妊娠选择性宫内生长受限儿预后及其超声特征

Prognosis and Ultrasonic Features of the Fetuses with Single Chorionic Twin Pregnancy with Selective Intrauterine Growth Restriction

目的探讨单绒毛膜双胎妊娠选择性宫内生长受限(s IUGR)胎儿预后及其超声特征。方法选择2010年9月至2015年9月大连市妇幼保健院和大连市妇女儿童医疗中心诊治的单绒毛膜双胎妊娠sIUGR孕妇90例为观察组,30例正常的双胎妊娠产妇为对照组。观察和比较两组胎儿预后、妊娠结局及不同预后单绒毛膜双胎妊娠sIUGR胎儿超声指标。结果观察组大胎儿及小胎儿体质量显著低于对照组[(2 167±421)g比(2 453±154)g,(1 511±376)g比(2 342±113)g](P<0.05)。死亡组胎儿sIUGR分型Ⅱ型和Ⅲ型[48.6%(17/35)、35.0%(7/20)]高于Ⅰ型17.1%(6/35),死亡组羊水过少者比例显著高于存活组[70.0%(21/30)比15.0%(9/60)](P<0.05)。结论sIUGR分型及羊水过少是影响单绒毛膜双胎妊娠sIUGR胎儿预后的重要原因,超声检查有助于临床评价。

Objective To analyze the influencing factors of prognosis and the ultrasonic features in single chorionic twin pregnancy fetuses with selective intrauterine growth restriction（ s IUGR）. Methods Total of 90 single chorionic twin pregnancy fetuses with s IUGR in Dalian City Maternity Hospital and Dalian Women and Children Medical Center from Sep.2010 to Sep. 2015 were included in the study,30 normal pregnant women with twin pregnancy were included as a control group. Fetal prognosis and pregnancy outcome of two groups were compared. The difference of ultrasonic features of the single chorionic twin pregnancy s IUGR fetuses with different prognoses were compared. Results The weight of large fetus[（ 2 167 ± 421） g]and small fetus [（ 1 511 ± 376） g] of the observation group were significantly lower than the control group＇s [（ 2 453 ± 154） g and（ 2 342 ± 113） g]（ P〈0. 05）. In the death group,fetal s IUGR typeⅡ and s IUGR type Ⅲ[48. 6%（ 17 /35）,35. 0%（ 7 /20） ]were higher than those of type Ⅰ（ 17. 1%,6 /35）. The proportion of oligohydramnios in the death group was significantly higher than the survivor group[70. 0%（ 21 /30） vs 15. 0%（ 9 /60） ]（ P〈0. 05）.Conclusion s IUGR typing and amniotic fluid are the important reasons that affect the prognosis of s IUGR fetus with twin pregnancy,and ultrasound examination is helpful for the clinical evaluation.