单绒毛膜双羊膜囊双胎选择性胎儿生长受限的临床分析  

Clinical Analysis of 24 Cases of sIUGR in Monochorionic Diamniotic Twin

作　　者：王佳倞 耿力[1] WANG Jialiang;GENG Li(Department of Obstetric,The First Affiliated Hospital of Kunming Medical University,Kunming Yunnan 650032,China)

机构地区：[1]昆明医科大学第一附属医院产科,云南昆明650032

出　　处：《实用妇产科杂志》2020年第4期289-293,共5页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:探讨单绒毛膜双羊膜囊双胎(MCDA)选择性胎儿生长受限(sIUGR)的临床特征、妊娠结局。方法:纳入2016年10月至2019年2月在我院产科分娩的24例MCDA sIUGR(sIUGR组)及同期分娩的42例非复杂性MCDA(对照组),对其临床资料进行回顾性分析。结果:sIUGR组异常脐带入口的发生率(45.8%)较对照组高(7.1%)(P<0.05);sIUGR组新生儿出生体质量及分娩孕周(大胎儿出生体质量1917.71±473.58 g,小胎儿1335.83±412.79 g;分娩孕周33.59±2.59周)均低于对照组(大胎儿出生体质量2329.52±392.42 g,小胎儿2140.95±392.42 g;分娩孕周35.79±2.21周)(P<0.05);sIUGR组新生儿轻度脑损伤发生率(52.1%)、转NICU率(70.8%)均高于对照组(15.4%、38.1%)(P<0.05)。两组间新生儿死亡率差异无统计学意义(P>0.05)。24例sIUGR患者中,Ⅰ型的大胎儿、小胎儿出生体质量分别高于Ⅱ型及Ⅲ型(P<0.05)。sIUGR组3种分型之间,新生儿发生轻度脑损伤差异有统计学意义(P<0.05)。sIUGR组中有20对围产儿均存活,4例存活儿围产期死亡;在孕26周前确诊为sIUGR较晚于孕26周确诊sIUGR的新生儿死亡率高(分别为20.0%及0),差异有统计学意义(P<0.05);sIUGR组3种分型之间新生儿死亡率差异无统计学意义(P>0.05)。结论:在孕26周前确诊为sIUGR较晚于26周确诊sIUGR的新生儿死亡率高;sIUGR组的3种分型中,Ⅱ型及Ⅲ型sIUGR双胎胎儿出生体质量均低于Ⅰ型。sIUGR围产儿预后与脐血流多普勒频谱类型密切有关。Objective:To discuss the clinical characteristics and pregnancy outcomes of selective intra-uterine growth restriction(sIUGR)inmonochorionic diamniotic twins(MCDA).Methods:24 cases of sIUGR delivered in the First Affiliated Hospital of Kunming Medical University from October 2016 to February 2019 were enrolled as sIUGR group.In addition,42 uncomplicated MCDA cases were included as the control group.The clinical data were retrospectively analyzed.Results:The rate of abnormal placental cord insertion in the sIUGR group(45.8%)was higher than that in the control group(7.1%)(P<0.05).The birth weight and gestational age of the newborns in the sIUGR group(birth weight of large fetus:1917.71±473.58g,birth weight of small fetus:1335.83±412.79g,gestational age of the newborns:33.59±2.59 weeks)were smaller than those in the control group(birth weight of large fetus:2329.52±392.42g,birth weight of small fetus:2140.95±392.42g,gestational age of the newborns:35.79±2.21week)(P<0.05).The incidence of mild cerebral injury and the rate of NICU admission in the sIUGR group(52.1%,70.8%)were higher than those in the control group(15.4%,38.1%)(P<0.05).There was no significant difference in neonatal mortality between the two groups(P>0.05).In the 24 cases of sIUGR,birth weight of large fetal and small fetal and gestational weeks at delivery in type I were bigger than those in typeⅡand typeⅢrespectively(P<0.05).There was a statistically significant difference in the incidence of mild cerebral injury among three types of sIUGR(P<0.05).In the sIUGR group,20 pairs of neonates survived,and 4 cases of death occurred in perinatal period.The incidence of neonatal mortality was higher in the cases diagnosed as sIUGR before 26 weeks than that of the cases diagnosed after 26 weeks(20.0%,0)(P<0.05).There was no significant difference in neonatal mortality among three types(P>0.05).Conclusions:The neonatal mortalityis higher if diagnosed as sIUGR before 26 weeks than in the cases diagnosed after 26 weeks.Among the three types of sIUGR,the

关 键 词：单绒毛膜双羊膜囊双胎 选择性胎儿生长受限 脐动脉血流多普勒频谱 脑室内出血 

分 类 号：R714[医药卫生—妇产科学]