一胎儿结构畸形双胎孕中期减胎术例临床分析

Clinical analysis of 335 cases of twin pregnancies with one structural anomalies undergoing elective termination during second trimester

目的探讨不同绒毛膜性的一胎儿结构畸形双胎胎儿畸形种类差异及不同孕周减胎术妊娠结局。方法回顾性分析2002—2020年在山东第一医科大学附属省立医院因一胎儿结构畸形行孕中期减胎术的双胎病例,分析双绒毛膜双胎(双绒双胎组)及单绒毛膜双胎(单绒双胎组)胎儿畸形种类及不同减胎孕周的妊娠结局。结果双绒双胎组颈部畸形占比高,两组其余胎儿畸形种类顺位基本一致。双绒双胎组A(12~13^(+6)孕周)、B(14~19^(+6)孕周)、C(20~27^(+6)孕周)3个亚组流产率、活产率差异无统计学意义,随减胎孕周的增加早产率增加,出生体重降低,差异均有统计学意义,A组早产率低于C组,A组及B组新生儿出生体重高于C组(A、B、C 3组的早产率分别为3.7%、13.9%和25.6%)。单绒双胎组A(12~19^(+6)孕周)、B(20~27^(+6)孕周)2个亚组流产率、早产率、活产率差异无统计学意义,A组新生儿分娩孕周及出生体重高于B组[分别为38^(+2)(37^(+4),40)vs.37^(+4)(34^(+5),38^(+5));3200(2938,3463)g vs.2800(2050,3175)g],且差异均有统计学意义。结论除颈部畸形外,两组胎儿结构畸形的顺位基本一致。双绒毛膜双胎一胎儿结构畸形在诊断胎儿畸形有减胎指征后应尽早减胎,不建议等待孕周更大后干预。单绒毛膜双胎一胎儿结构畸形尽早减胎可能收到更好妊娠结局。

Objective To analyze the fetal abnormality differences of the different chorionic twin pregnancy with one structural deformity fetus and investigate the outcomes of elective termination at different gestational age.Methods The twin pregnancies with one tructural deformity fetus undergoing elective termination during second trimester in Shandong Provincial Hospital Affiliated to Shandong First Medical University from 2002 to 2020 were retrospectively analyzed.Analyze the differences of abnormality types and the outcomes of elective termination at different gestational age between monochorionic twins(MC group)and dichorionic twins(DC group).Results The proportion of neck deformity in the dichorionic group was higher,and the order of the other fetal malformations was basically the same.The group of DC was divided into A(12~13^(+6)weeks),B(14~19^(+6)weeks)and C(20~27^(+6)weeks)subgroups according to the gestational week of elective termination.The abortion rates and live birth rates of three subgroups had no statistical difference.The preterm birth rate increased and the birth weight decreased with the increase of gestational age,and the differences were statistically significant(the pretern birth rates of A,B,C groups was 3.7%、13.9%、25.6%).The preterm birth rate in group A was lower than that in group C and the birth weight of newborns in group A and B was better than that in group C.The group of MC was divided into A(12~19^(+6)weeks)and B(20~27^(+6)weeks)subgroups according to the gestational week of elective termination.The abortion rate,preterm birth rate and live birth rate of the two subgroups had no statistical difference.The gestational age of delivery and the birth weight in group A were better than those in group B[38^(+2)(37^(+4),40)vs.37^(+4)(34^(+5),38^(+5);3200(2938,3463)g vs.2800(2050,3175)g],and the differences were statistically significant.Conclusions The sequence of fetal structural malformations in DC and MC are basically the same except for neck deformity.Eelective termination should be performed as soon as possible when there are indications of fetal reduction in the diagnosis of fetal malformation in dichorionic twin pregnancies with one structural anomalies,and it is not recommended to wait for the intervention after the gestational week is greater.The early reduction of a fetus with structural malformation may achieve a better outcome in monochorionic twins.