单绒毛膜单羊膜囊双胎脐带缠绕1例并文献复习

Monochorionic monoamniotic twin umbilical cord tangling of a case report and literature review

本文报道1例孕妇,孕期未规律产检,孕32+1周因先兆早产首次就诊于我院,结合孕早期超声结果,诊断为单绒双胎,入院后给予硫酸镁保护胎儿神经系统、促胎肺成熟等治疗,于孕32+3周行剖宫产术,术中娩出两活婴,长女头位娩出,体重1600 g,1 min Apgar评分9分(皮肤颜色减1分);次女臀位娩出,体重1700 g,1 min Apgar评分7分(呼吸、肌张力、皮肤颜色各减1分),5 min Apgar评分9分(皮肤颜色减1分),两胎儿间无隔膜,胎盘娩出后见两脐带长约50/55 cm,脐带根部紧邻,两根脐带复杂缠绕6周并呈脐带真结,手术顺利。患者术后恢复好,如期出院。长女因新生儿坏死性小肠结肠炎继发DIC,于儿科住院36 d后家属放弃治疗,次女于儿科住院52 d后出院,现生长发育良好。

This paper reports a pregnant woman who had irregular prenatal examination during pregnancy and first visited our hospital at 32+1 weeks of gestation due to threatened preterm labor.She was diagnosed with monochorionic twins,combined with the results of ultrasound in the first trimester.After admission,magnesium sulfate was given to protect the fetal nervous system and induce lung maturation.Cesarean section was performed at 32+3 weeks of gestation.Two live infants were delivered during surgery.The eldest daughter was delivered in the head position,weighing 1600 g,and Apgar score at 1 minute was 9(skin color was reduced by 1 point).The second daughter was delivered in the hip position,weighing 1700 g,with an Apgar score of 7 at 1 minute(breath,muscle tension,skin color reduced by one point each)and nine at 5 minutes(skin color reduced by one point).There was no diaphragm between the two fetuses.After delivery of the placenta,the two umbilical cords were about 50/55 cm in length.The root of the umbilical cord was immediately adjacent.The two umbilical cords were complex entangled for six circles showed proper knots of the umbilical cord,and the operation was uneventful.The patient recovered well after surgery and was discharged as scheduled.The eldest daughter was hospitalized in pediatrics because of DIC secondary to neonatal necrotizing enterocolitis.After 36 days of hospitalization,family members gave up treatment.The second daughter was discharged after hospitalizing in the Department of Pediatrics for 52 days.The growth and development were good.