双胎妊娠一胎21-三体综合征的妊娠结局

Pregnancy outcome of twin pregnancies with one fetus trisomy 21 syndrome

目的对45例产前诊断为一胎21-三体综合征的双胎妊娠孕妇进行妊娠结局分析。方法回顾性分析2011~2020年在同济大学附属第一妇婴保健院产前诊断证实双胎之一21-三体综合征的45例孕妇的临床资料,关注产前羊水穿刺指征及妊娠选择,分析减胎效果、流产率、分娩孕周及新生儿结局。结果44例双绒毛膜双羊膜囊双胎(简称双绒双胎)一胎21-三体综合征均接受了氯化钾减胎。1例单绒毛膜双羊膜囊双胎(简称单绒双胎)一胎21-三体综合征拒绝射频消融减胎,分娩一个正常婴儿和一个唐氏综合征婴儿。44例氯化钾减胎术后均无发生严重并发症,流产率为2.3%(1/44);围产儿存活率为97.7%,其中早产儿占29.6%(13/44)。分娩孕周平均为(36.4±3.7)周;整体新生儿平均出生体重为(2798.6±673.0)g,结局良好,均无出生缺陷,身高、体重、智力发育等各项指标均正常。17~24周进行减胎术的早产率(16.7%)低于24周后减胎的病例(45%)(P=0.04),差异具有统计学意义。结论①双胎一胎染色体异常胎儿进行选择性减胎术,安全性及妊娠结局良好;②精准的双胎羊穿标识和术后被减去胎儿的染色体验证可确保减胎的准确性;③双胎羊水穿刺应在有资质做宫内治疗的产前诊断中心或区域性胎儿医学中心进行。

Objective Toevaluate the perinatal outcome of 45 twin-pregnancies diagnosed with one fetus trisomy 21prenatally.Methods The clinical data of 45 pregnant women diagnosed as one fetus 21 trisomy syndromes at Shanghai First Maternity and Infant Health Hospital from 2011 to 2020 were analyzed retrospectively.The indications of invasive procedures and pregnancy decisions were focused,as well as fetal reduction effect,miscarriage rate,gestational week of delivery and neonatal outcome were concerned.Results Transabdominal of KCl fetal reduction was performed in 44 dichorionic diamniotic(DCDA)cases.One case of monochorionic diamniotic(MCDA)refused radiofrequency ablation reduction,and gave birth to a normal baby and a Down syndrome baby.No serious complications occurred in 44 cases with KCl reduction,the miscarriage rate was 2.3%(1/44),while the survival rate was 97.7%,of which the preterm infants accounted for 29.6%(13/44).The average gestational week of delivery was(36.4±3.7)week;the overall average birth weight of newborns was(2798.6±673.0)g.None of newborns had birth defects,and the height,weight,intellectual development and other indicators were normal.The premature birth rate(16.7%)of fetal reduction surgery at 17-24 week was lower than that of fetal reduction after 24 week(45%)(P=0.04),and the difference wasstatistically significant.Conclusions①Selective fetal reduction for co-twin chromosomal abnormalities is safe and reach a good pregnancy outcome.②Combining precise twin amniocentesis identification and postoperative chromosomal verifications of the fetus reduced could avoid mis-operation.③Invasive prenatal diagnosis procedures should be performed in a prenatal diagnosis center or regional fetal medical center that is qualified for fetal treatment.