双胎妊娠1530例胎儿丢失临床分析

Fetal loss in twin pregnancies:clinical analysis of 1530 cases

目的探讨双胎妊娠不同绒毛膜性胎儿在不同孕周发生围产儿丢失的风险及单绒毛膜双羊膜囊双胎(MCDA)胎儿丢失的原因。方法回顾性分析2014年1月至2017年12月中国内地10所三级妇产科专科医院或妇幼保健院中分娩的1530例双胎妊娠,比较MCDA与双绒毛膜双羊膜囊双胎(DCDA)胎儿丢失的风险和发生孕周及原因。结果 407例MCDA和1123例DCDA纳入研究。1239+6周MCDA组丢失率为4.68%,DCDA组丢失率为0.98%,丢失风险OR 4.78(95%CI 2.848.03),χ^(2)=42.45,P<0.001。12~23^(+6)周MCDA组较DCDA组丢失风险OR6.09(χ^(2)=29.53,P<0.001)。24~39^(+6)周MCDA组较DCDA组丢失风险OR 5.03(χ^(2)=18.73,P<0.001)。MCDA组胎儿丢失原因的前4位依次为:双胎输血综合征(twin-twin transfusion syndrome,TTTs)(36.36%,8/22)、选择性胎儿生长受限(selective intrauterine growth restriction,sIUGR)(22.73%,5/22)、脐带扭转(22.73%,5/22)、帆状胎盘(13.64%,3/22)。DCDA组胎儿丢失原因的前4位依次为:胎膜早破(21.43%,3/14)、胎儿生长受限(fetal growth restriction,FGR)(14.29%,2/14)、胎儿结构异常(14.29%,2/14)、母体感染(7.14%,1/14)。结论 MCDA胎儿丢失风险明显高于DCDA。单绒毛膜性双胎特有的并发症(TTTs、sIUGR)及脐带扭转等都是造成MCDA胎儿丢失的重要原因。

Objective To study the risk of perinatal fetal loss in MCDA/DCDA twin pregnancy at different gestational age and explore the high risk factors of fetal loss in MCDA twin pregnancy.Methods A retrospective analysis was performed in 1530 cases of twin pregnancies in 10 tertiary obstetrics and gynecology hospitals or MCH hospitals in China's Mainland between January 2014 and December 2017.The risks of fetal loss in different gestational ages and high risk factors were compared between MCDA and DCDA twin pregnancy.Results The analysis included 1530 twin pregnancies(407 MCDA and 1123 DCDA).The total risk of fetal and perinatal infant loss in 12-39^(+6) weeks of gestation was significantly higher in MCDA twins(4.68 per 100 fetuses) than in DCDA twins(0.98 per 100 fetuses),with an OR of4.78(95%CI 2.848.03,χ^(2)=42.45,P<0.001).The OR in 12-23^(+6) weeks of gestation was 6.09(χ^(2)=29.53,P<0.001),while in 24-39+6 weeks of gestation it was 5.03(χ^(2)=18.73,P<0.001).The top 4 causes of fetal loss in MCDA twins were TTTs(36.36%,8/22),sIUGR(22.73%,5/22),umbilical cord torsion(22.73%,5/22) and velamentous placenta(13.64%,3/22).Premature rupture of membranes(21.43%,3/14),FGR(14.29%,2/14),fetal structural abnormality(14.29%,2/14),and maternal infection(7.14%,1/14) were the top 4 causes in DCDA twins.Conclusion The risk of fetal loss in MCDA twins is significantly higher than that in DCDA twins.The specific complications of MC twins(TTTS,sIUGR)and umbilical cord torsion are the important causes of fetal loss of MCDA.