单绒毛膜双胎围产结局单中心大样本分析

Perinatal outcome of monochorionic twins:a single center analysis

目的:对单中心大样本单绒毛膜双羊膜囊双胎(monochorionic diamniotic twin,MCDA)围产结局进行分析,探讨围产儿预后,为产前咨询和临床处理提供依据。方法:回顾性分析299对MCDA新生儿资料。根据是否出现并发症,分为无并发症组、双胎输血综合征(twin-twin transfusion syndrome,TTTS)组、选择性宫内生长受限(selective intrauterine growth restriction,sIUGR)组和双胎贫血-红细胞增多序列综合征(twin anemia-polycythemia sequence,TAPS)组,对各组围产结局进行比较。结果:TTTS组、TAPS组分娩孕周均少于无并发症组。并发症组大小胎儿出生体质量均低于无并发症组(P<0.05);并发症组双胎出生体质量差异>25%的发生率均明显高于无并发症组(P<0.01)。TTTS组、sIUGR组围产儿死亡率分别为8.8%、3%,均明显高于无并发症组(1.5%,P<0.05)。MCDA先天畸形发生率高,其中心血管系统畸形、骨骼四肢畸形、泌尿系统畸形占前3位。TTTS组先天畸形发生率高于无并发症组及sIUGR组(P<0.05)。结论:MCDA合并TTTS、sIUGR者围产结局不良;有MCDA并发症孕妇需加强定期产检以改善胎儿预后。

Objective:To analyze the perinatal outcome of monochorionic diamniotic twins(MCDA),so as to explore the prognosis of perinatal fetus and provide a theoretical basis for prenatal counseling and clinical management.Methods:A retrospective study was conducted on 299 cases of MCDA.According to the complications,the cases were divided into non-complication group,twin-twin transfusion syndrome(TTTS)group,selective intrauterine growth restriction(sIUGR)group,and twin anemia-polycythemia sequence(TAPS)group.The perinatal outcome was compared among four groups.Results:In TTTS and TAPS group,the gestational age at delivery was significantly less compared with that in non-complication group.In three complication groups,the average birth weight of little fetuses was significantly less compared with that in non-complication group(P<0.05),moreover,for birth weight difference of the twin,the incidence of>25%was also significantly higher(P<0.01).The incidence of perinatal death in TTTS group(8.8%)and sIUGR group(3%)was significantly higher than that in non-complication group(1.5%,P<0.05).The incidence of congenital malformations was high in MCDA,among which,deformities in cardiovascular system,skeletal systemand urinary system were on the top three.The incidence of congenital malformations in TTTS group was significantly higher than that in non-complication group and sIUGR group(P<0.05).Conclusions:MCDA complicated with TTTS or sIUGR has poor perinatal outcome.For those pregnant women with MCDA complications,the regular prenatal examination is required to be strengthened for improving the fetal prognosis.