双胎不同类型选择性胎儿生长受限的妊娠结局分析

The Analyze of Outcomes of Monochorionic Twins with Selective Intrauterine Growth Restriction

目的:分析单绒毛膜双羊膜囊双胎不同类型选择性胎儿生长受限(sIUGR)孕妇的妊娠结局。方法:选择2015年1月至2018年12月于四川大学华西第二医院孕26周前诊断为sIUGR的48例双胎孕妇进行回顾性分析。根据脐动脉(UA)血流频谱变化将其分为Ⅰ型(UA频谱正常,27例)、Ⅱ型(UA舒张末期血流持续性缺失或反向,16例)、Ⅲ型(UA舒张末期血流间断性异常,5例),分析3种类型sIUGR孕妇的妊娠结局和胎儿的临床转归。结果:(1) 3组间的分娩孕周及sIUGR胎儿出生体质量比较,差异有统计学意义(P<0.05),且与Ⅰ型相比,Ⅱ型sIUGR分娩孕周更小、生长受限(IUGR)胎儿出生体质量更低(P<0.05);(2) 3组间总体围产期死亡率比较,差异有统计学意义(P<0.05),与Ⅰ型相比,Ⅱ型总体围产期死亡率更高(P<0.05);(3) 3组间总体新生儿完好存活率比较,差异有统计学意义(P<0.05),与Ⅱ型、Ⅲ型相比,Ⅰ型总体新生儿完好存活率更高(P<0.05)。结论:不同类型sIUGR胎儿的转归及结局存在多样性,其中Ⅱ型预后最差;UA血流频谱异常可提示不良妊娠结局,应密切加强产前监测,有助于临床确定分娩时机,提高围产儿存活率。

Objective:To evaluate the outcomes of monochromic diamniotic twins with different types of selec-tive intrauterine growth restriction(sIUGR).Methods:From January 2015 to December 2018,48 pregnant women with twins diagnosed with sIUGR before 26 weeks of pregnancy in the West China Second Hospital of Sichuan U-niversity were analyzed retrospectively.According to the changes of blood flow spectrum of umbilical artery(UA),it was divided into three types:typeⅠ(normal UA spectrum,27 cases),typeⅡ(constantly absent/reverse of UA end-diastolic blood flow,16 cases)and typeⅢ(intermittently absent/reverse of UA end-diastolic blood flow,5 ca-ses).The pregnancy outcome of each type of pregnant women and the clinical process of twins were analyzed.Results:①A statistically significant variance exists in the gestational age at delivery and birth weight of IUGR fe-tuses across the three groups(P<0.05).TypeⅡsIUGR is correlated with lower birth weight and earlier gesta-tional age at delivery compared with typeⅠ(P<0.05).②A statistically significant discrepancy is observed in the overall perinatal mortality rate among the groups,with typeⅡexhibiting a higher rate compared to typeⅠ(P<0.05).③There is a statistically significant difference in the overall neonatal survival rate in good condition among the three groups.TypeⅠhas a higher overall neonatal survival rate in good condition compared to typesⅡandⅢ(P<0.05).Conclusions:The clinical process and outcomes varied among the three types of sIUGR,in which typeⅡis the worst.Abnormal umbilical artery Doppleris associated with poor prognosis and therefore close moni-toring is warranted,to help determining the time of deliver,and improve perinatal survival ratey.