早孕期超声筛查双胎妊娠的价值

Value of ultrasound in twin pregnancies during early trimmest

目的探讨超声在早孕期(孕11~13^+6周)双胎妊娠筛查中的价值。方法选取接受早孕期超声筛查的196名双胎孕妇,判断其绒毛膜性及羊膜性,测量胎儿头臀长及颈项透明层(NT)厚度,系统检查胎儿结构,检查胎儿是否存在结构畸形,并随访妊娠结局。结果196名双胎孕妇中,双绒毛膜囊双羊膜囊(DCDA)双胎149名,单绒毛膜囊双羊膜囊(MCDA)双胎43名,单绒毛膜囊单羊膜囊(MCMA)双胎4名。超声筛查共发现36名孕妇存在异常胎儿,包括DCDA双胎30名,MCDA双胎4名,MCMA双胎2名。DCDA双胎中异常胎儿30胎,均为双胎之一异常,其中1胎为多发畸形(脊柱及双下肢发育异常),1胎可见颈部水囊瘤,25胎停止发育,3胎NT增厚。MCDA共检出异常胎儿6胎,1胎双胎之一为无心畸胎;1胎双胎之一颈部水囊瘤形成;双胎中1胎胚胎停育,另1胎颈部水囊瘤形成;双胎均停止发育。MCMA双胎中,1胎双胎之一脑膜脑膨出,另2胎为胸腹连体双胎。结论早孕期超声检查对于确定绒毛膜性和羊膜性双胎以及筛查胎儿严重结构畸形和双胎特有并发症具有重要临床意义。

Objective To explore the value of ultrasound in screening of twin pregnancies during early trimmest (11-13 ^+6 weeks). Methods Totally 196 twin pregnant women who received prenatal ultrasonography at 11-13 +6 weeks were enrolled, among them the twins were classified as chorionic and amniotic. The fetal-rump length and nuchal translucency (NT) were measured, the fetal structures were examined systematically to detect structural abnormalities, and the pregnancy outcomes were followed up. Results Among 196 twin pregnant women, dichorionic and diamniotic (DCDA) twins were found in 149 women, monochorionic and diamniotic (MCDA) twins were found in 43 women, while monochorionic and monoamniotic (MCMA) twins were observed in 4 women. Ultrasonography showed that 36 pregnant women had abnormal fetuses, including 30 DCDA twins, 4 MCDA twins and 2 MCMA twins. A total of 30 abnormal fetuses were detected in DCDA twins, all were one of the twins, including one with spine and lower limbs abnormally developed, one with neck water cyst, one of twins stopped developing in 25 cases and one of twins with thickened NT in 3 cases. A total of 6 abnormal fetuses were detected in MCDA twins, including one fetus without cardiac twins sequence, one of twins with neck water cyst in one case, one of the twins stopped developing and the other with neck water cyst in one case, and both twins stopped developing in one case. Among MCMA twins, encephalomeningocele was found in one of twins in one case, while conjoined twins were detected in one case. Conclusion Ultrasound screening plays a very important role in diagnosing chorionic and amniotic, detecting fetal structural abnormalities and complications of twins during early trimmest.