单绒毛膜单羊膜囊双胎妊娠17例临床分析  

Monochorionic monoamniotic twin pregnancy： a review of 17 cases

作　　者：邵长香 孙路明[1] 邹刚[1] 孙琦[1] 周奋翮[1] 周艳[1] 

机构地区：[1]同济大学附属第一妇婴保健院产科,上海200040

出　　处：《中华围产医学杂志》2014年第9期609-613,共5页Chinese Journal of Perinatal Medicine

基　　金：上海市科学技术委员会科研计划项目（134119a4400）

摘　　要：目的 总结单绒毛膜单羊膜囊（monochorionic monoamniotic,MCMA）双胎妊娠的诊断、妊娠期监护、处理及妊娠结局. 方法 2010年7月至2013年8月共1 7例MCMA双胎妊娠孕妇在同济大学附属第一妇婴保健院接受产前检查并分娩.明确诊断的MCMA双胎根据具体情况采取引产、选择性减胎术及期待妊娠3种处理方式.选择期待妊娠的MCMA孕妇每2周1次定期随访;28周促胎肺成熟;28～30周入院监测：每日连续40 min胎儿电子监护,每周监测脐血流2次;30～32周：每日2次连续40 min胎儿电子监护,隔日行脐血流监测;32～34周：每日至少3次连续40 min胎儿电子监护,每日行脐血流及生物物理学评分检查,适时终止妊娠.总结合并脐带缠绕、胎儿先天性畸形、胎死宫内、单绒毛膜双胎妊娠特殊并发症（如选择性胎儿生长受限、双胎反向动脉灌注序列征及双胎输血综合征）情况及妊娠结局. 结果 17例MCMA双胎孕妇平均年龄为（29.0±2.7）岁（24～33岁）,均为初产妇,平均诊断MCMA的孕周为（18.6±5.5）周（11 ＋5～28＋1周）.1 7例MCMA双胎孕妇产前超声均提示脐带缠绕,且均得到产后证实.并发胎儿畸形7例,发生单绒毛膜双胎妊娠特殊并发症3例,其中双胎反向动脉灌注序列征1例,选择性胎儿生长受限2例.7例并发胎儿畸形孕妇中的4例选择引产;1例并发胎儿之一无脑畸形孕妇行射频消融减胎术.另2例并发胎儿畸形者和10例无胎儿畸形的孕妇均选择期待妊娠,期间超声均无异常提示.但其中2例分别于妊娠16和21＋1周超声监测发现2胎儿均胎死宫内,行引产术;1例住院监测期间妊娠30＋2周发生一胎胎死宫内,急诊剖宫产终止妊娠.共11例孕妇活产分娩,平均于（32.7±1.6）周行剖宫产.其中4例考虑脐带因素急诊手术分娩.活产新生儿共20例,平均出生体重为（1 850±496）g.1 6例新生儿转新生儿重症监护病房,平均人住（37.9±16.4）d;9例新�Objective To review the diagnosis,monitoring,management and perinatal outcomes of monochorionic monoamniotic （MCMA） twin pregnancy.Methods From July 2010 to August 2013,there were 17 MCMA twin pregnancies diagnosed and delivered in Shanghai First Maternity and Infant Hospital.According to the MCMA management protocol,induced abortion,elective fetal reduction,and anticipant pregnancy were optional.For those anticipant pregnancies,fetal lung underwent maturation promotion at gestational weeks 28; hospitalization with 40 min/day continual fetal electronic monitoring and umbilical blood monitoring twice weekly at gestational weeks 28-30; 40 min continual fetal electronic monitoring twice daily and umbilical blood monitoring once every other day at gestational weeks 30-32; and 40 min continual fetal electronic monitoring three times daily and umbilical blood monitoring once daily at gestational weeks 32-34; and pregnancy ended on time.The presence of umbilical cord entanglement,congenital malformation,intrauterine fetal death,complications exclusive to monochorionic twins （e.g.selective fetal growth restriction,twin reversed arterial perfusion sequence and twin-twin transfusion syndrome） and the perinatal outcomes were retrospectively analyzed.Results Average maternal age of women with 17 MCMA twins was （29.0±2.7） years,and all were primiparas.They were diagnosed at （18.6± 5.5） weeks on average （11 ＋5-28＋1 weeks）.Umbilical cord entanglements were detected in all cases by ultrasonography and confirmed postnatally.There were three cases of complications specific to monochorionic twins,including two with selective fetal growth restriction and one with twin reversed arterial perfusion sequence.There were seven women with fetal congenital malformation; four of whom chose induced abortion; one case of anencephaly chose radiofrequency ablation fetal reduction,and the remaining two cases with congenital malformation and ten cases without chose anticipant pregnancy,and there were no abnormal ultrasono

关 键 词：双生 单绒毛膜 超声检查 产前 胎儿监测 妊娠结局 

分 类 号：R714.23[医药卫生—妇产科学]