双胎妊娠并发脐带缠绕打结6例临床分析

Twin Pregnancy With Knotting and Entanglement of Umbilical Cords:A Review of 6 Cases

目的通过回顾性分析单绒毛膜单羊膜囊双胎妊娠病例资料,了解并发脐带缠绕打结的妊娠结局。方法回顾性分析2015年6月—2019年12月于某三级甲等妇幼专科医院分娩的6例双胎妊娠并发脐带缠绕打结孕产妇的妊娠结局及围产儿预后。结果 6例均为单绒毛膜单羊膜囊双胎,并发脐带缠绕打结的发生率为27.3%(6/22)。分娩孕周平均(34.7±1.9)周,分娩方式均为剖宫产。其中5例为早产,2例脐带过长,2例羊水Ⅲ°浑浊,11个活产新生儿中,9个新生儿因早产入住新生儿高危观察室,2个新生儿因气促入住新生儿科,随访42 d均正常。1例在妊娠32周时发现双胎之一死胎。结论双胎脐带缠绕为单绒毛膜单羊膜囊双胎特有并发症,对胎儿和新生儿产生重要影响,孕期应尽早确定绒毛膜性,严密孕期监护,32~34周剖宫产方式终止妊娠,以改善围产儿的预后。

Objective To understand the pregnancy outcome of knotting and entanglement of umbilical cords by retrospective analysis of cases of monochorionic monoamniotic twin pregnancy.Methods The pregnancy outcome and perinatal prognosis of 6 cases of twin pregnancy with knotting and entanglement of umbilical cords in a first-class grade A specialized hospital from June 2015 to December 2019 were analyzed retrospectively.Results All the cases were monochorionic monoamniotic twin pregnancy,and 6 cases of twin pregnancy with knotting and entanglement of umbilical cords were found,the incidence being 27.3%(6/22).The average gestational age of delivery was(34.7±1.9)weeks,and the mode of delivery was cesarean section.Among them,5 cases were premature delivery,2 cases were excessively long cord,2 cases at amniotic fluid turbidityⅢdegree;among 11 live births,9 cases were admitted in neonatal high-risk observation room due to premature delivery,2 cases were admitted in the neonatal department due to short breath,all of which were normal after 42 days follow-up;one of the twins was stillborn at 32 weeks of gestation.Conclusion Twin pregnancy with knotting and entanglement of umbilical cords,a unique complication of monochorionic monoamniotic twin pregnancy,has an important impact on the fetus and the newborn.Early diagnosis of chorionic nature,strict monitoring during pregnancy,and termination of pregnancy by cesarean section at 32-34 weeks are helpful to improve the perinatal prognosis.