超声预测单绒毛膜双胎中选择性宫内生长受限儿妊娠结局  

Ultrasound Prediction for Pregnancy Outcome of Monochorionic Twins with Selective Intrauterine Growth Restriction

作　　者：薛敏[1] 张雁[1] 曲侠[1] 胡海云[1] 张晶莉[1] 

机构地区：[1]北京大学深圳医院超声影像科,广东深圳518036

出　　处：《武汉大学学报（医学版）》2012年第4期549-552,共4页Medical Journal of Wuhan University

摘　　要：目的:分析单绒毛膜(MC)双胎中选择性宫内生长受限儿(sIUGR)发生宫内死亡与超声监测指标的相关性,探讨超声预测sIUGR宫内死亡的指标。方法:回顾分析我院71例孕28周前诊断为sIUGR并行期待治疗胎儿的病例资料。超声监测的指标包括:生长发育参数;大脑中动脉频谱异常,羊水过少;羊水过多;脐动脉频谱;静脉导管频谱;大脑中动脉频谱。经Logistic回归分析筛选sIUGR发生宫内死亡的预测指标。结果:MC双胎中sI-UGR静脉导管a波消失或反向、脐动脉舒张末期血流消失或反向与sIUGR的死亡存在相关性,P均<0.05,而脐动脉舒张末期血流正常频谱、大脑中动脉频谱异常羊水过多及羊水过少与sIUGR死亡无相关性,P>0.05。Logis-tic回归分析显示,静脉导管a波消失或反向是sIUGR死亡的独立预测指标,OR=51.392;P<0.05。结论:MC双胎中sIUGR发生宫内危象的超声征像是:MC双胎中sIUGR脐动脉舒张末期血流消失或反向,静脉导管a波消失或反向。静脉导管a波消失或反向可用于临床指导确定分娩时机。Objective： To evaluate the use of ultrasound assessment to predict the risk of intrauterine fetal demise（IUFD） in monochorionic（MC） twins with selective intrauterine growth restriction（sIUGR）.Methods： The data of 71 MC twins pregnancies diagnosed with sIUGR before 28 weeks of gestation were reviewed.All patients were under expectant management during the observation period.The ultrasonic findings such as growth parameters,oligohydramnios,polyhydramnios,and Doppler spectrums of umbilical artery（UA）,ductus venosus（DV） and middle cerebral artery（MCA） were analyzed.The relationships between these ultrasound findings and IUFD of sIUGR were evaluated using multiple logistic regression analysis.Results： There were several factors associated with IUFD in MC twins with sIUGR,including absent or reversed a-wave of DV;absent or reversed end-diastolic flow in the UA（P0.05）.While the normal UA Doppler,abnormal MCA Doppler,polyhydramnios and oligohydramnios were not associated with IUFD in MC twins with sIUGR（P0.05）.Multiple logistic regression analysis revealed that the absent or reversed a-wave of DV（odds ratio,OR=51.392;P0.05） was a significant risk factor for IUFD.Conclusion： The absent or reversed end-diastolic flow of UA and absent or reversed a-wave of DV showed the worst prognosis.Absent or reversed a-wave of DV should be recognized as an important indicator for IUFD in MC twins with sIUGR to clinically determine the time of delivery.

关 键 词：超声检查 单绒毛膜双胎 选择性宫内生长受限 妊娠结局 

分 类 号：R714.431[医药卫生—妇产科学]