双绒毛膜双羊膜囊双胎妊娠一胎染色体非整倍体选择性减胎术20例分析  

Selective termination of dichorionic diamniotic twins discordant for chromosomal aneupioidy： analysis of 20 cases

作　　者：黄轩[1] 罗艳敏[1] 黄林环[1] 周祎[1] 陈健生[1] 陈筠虹[1] 黄爱兰[1] 方群[1] 

机构地区：[1]中山大学附属第一医院妇产科,广州510080

出　　处：《中华围产医学杂志》2014年第11期733-737,共5页Chinese Journal of Perinatal Medicine

摘　　要：目的探讨妊娠中晚期双绒毛膜双羊膜囊双胎（dichorionic diamniotic twin，DCDA）妊娠一胎染色体非整倍体进行氯化钾选择性减胎术的策略和妊娠结局。方法2008年6月1日至2012年12月30日在中山大学附属第一医院妇产科胎儿医学中心就诊的DCDA孕妇20例，产前诊断一胎染色体非整倍体，另一胎核型正常，于妊娠14～34周对异常胎儿实施心脏注射氯化钾减胎术。分析术后流产、胎膜早破、早产等并发症及新生儿结局。结果孕妇平均年龄为（33．8±4．3）岁，平均减胎孕周为（23．4±5．8）周，≤妊娠20周减胎6例、21～27周减胎8例、≥28周减胎6例。17例被减胎有畸形等明显减胎标记，3例仅有超声软指标或胎儿位置差别等弱减胎标记。20例均减胎成功，20％（4／20）术后流产，35％（7／20）早产，45％（9／20）足月分娩，总体新生儿存活率为65％（13／20），无一例发生宫内感染。近宫颈胎儿和远离宫颈胎儿减胎后未足月胎膜早破发生率分别为7／12和0／8。结论对妊娠中晚期DCDA一胎染色体非整倍体进行氯化钾选择性减胎术，母体安全，减胎成功率高。减灭近宫颈的胎儿时，未足月胎膜早破发生率高。Objective To investigate the strategy and pregnancy outcomes of dichorionic diamniotic twins discordant for chromosomal aneuploidy undergoing selective termination with potassium chloride during the second and third trimester. Methods Twenty dichorionic diamniotic twins, discordant for chromosomal aneuploidy, who underwent selective termination in First Affiliated Hospital of Sun Yat-Sen University between June 1, 2008 and December 30, 2012 were retrospectively analyzed. Chromosomal discordance was confirmed by karyotype analysis and （ or ） chromosome detection. Abnormal fetuses were terminated by the injection of potassium chloride into the fetal heart. The incidence of miscarriage, premature rupture of membranes, preterm labor and other complications after feticide were analyzed. Results The mean maternal age was （ 33.8 ~ 4.3 ） years, and gestational age at feticide was （ 23.4 ___ 5.8 ） weeks. Six cases underwent feticide ~〈 20 weeks, eight at 21-27 weeks and six at /〉 28 weeks. Severe sonographic markers leading to feticide included fetal anomaly in 17 cases, and weak sonographic markers, such as abnormal soft index or fetal position difference, were seen in three cases. Following successful feticide in all 20 cases, 4/20 （ 20% ） cases experienced miscarriage, 7/20 （ 35% ） ended pretermly, 9/20 （ 45% ） delivered at full term, and 13/20 （ 65% ） had healthy babies. No intrauterine infection was observed. The incidence of preterm premature rupture of membranes was 7/12 and 0/8 in the terminated presenting fetuses and non-presenting fetuses,respectively. Conclusions Selective termination in dichorionic diamniotic twins discordant for chromosome aneuploidy is a safe procedure for mothers with a high success rate. The rate of preterm premature rupture of membranes is high in the terminated presenting fetuses.

关 键 词：妊娠 双胎 非整倍性 染色体畸变 妊娠减少 多胎 

分 类 号：R719[医药卫生—妇产科学]