单绒毛膜单羊膜囊双胎妊娠的临床特点及妊娠结局分析  

Clinical characteristics and outcome of monochorionic monoamniotic twin pregnancy

作　　者：张春妤[1] 魏瑗[1] 赵扬玉[1] Zhang Chunyu;Wei Yuan;Zhao Yangyu(Department of Obstetrics and Gynecology,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院妇产科,100191

出　　处：《中华妇产科杂志》2020年第9期627-632,共6页Chinese Journal of Obstetrics and Gynecology

基　　金：国家重点研发计划(2016YFC1000400,2016YFC1000408)。

摘　　要：目的探讨单绒毛膜单羊膜囊(MCMA)双胎妊娠的临床特点及妊娠结局。方法收集2011年1月至2019年12月在北京大学第三医院终止妊娠的60例MCMA双胎妊娠孕妇的临床资料,对其一般情况、产前检查情况及妊娠结局进行回顾性分析。结果60例MCMA双胎妊娠孕妇的年龄为(31.0±4.1)岁,其中,初产妇44例(73%,44/60)、经产妇16例(27%,16/60)。经产前诊断并在产后证实为MCMA双胎妊娠58例,中位超声确诊时间为12周(范围:8~30周)。60例MCMA双胎妊娠中,产前超声检查提示6例合并联体双胎、5例合并双胎动脉反向灌注序列征(TRAPS)、另有10例存在其他胎儿结构畸形。60例MCMA双胎妊娠孕妇中,19例孕28周内自然流产或由于胎儿畸形、胎死宫内等原因引产,41例进入围产期,共70例新生儿存活。围产儿死亡的最主要原因为胎儿发育异常。结论MCMA双胎妊娠有较高的胎儿异常发生率和围产儿死亡率,早期诊断、加强孕期管理及监测、制订个体化诊疗方案是改善妊娠结局的关键。Objective To investigate the clinical characteristics and outcomes of monochorionic monoamniotic(MCMA)twin pregnancy.Methods The clinical data of 60 MCMA twin pregnant women who were terminated in Peking University Third Hospital from January 2011 to December 2019 were collected,and the general clinical data,prenatal exami nation and pregnancy outcomes were analyzed retrospectively.Results The age of 60 MCMA twin pregnant women was(31.0±4.1)years old,among which 44 cases were primiparas(73%,44/60)and 16 cases were multiparas(27%,16/60).Fifty-eight cases were diagnosed as MCMA twin pregnancy prenatally and were confirmed after delivery.Median ultrasonic diagnosis of gestational age was 12 weeks(range:8-30 weeks).In the 60 MCMA twin pregnancies,6 cases were conjoined twins,5 cases were complicated with twin reversed arterial perfusion sequence(TRAPS),and 10 cases were diagnosed as other fetal malformation by prenatal ultrasound examination.Among the 60 MCMA twin pregnant women,19 cases had spontaneous abortion or induced abortion due to fetal malformation,fetal death or other reasons within 28 weeks of pregnancy,41 cases entered the perinatal period,a total of 70 newborns survived.The main cause of perinatal fetal or neonatal death was fetal dysplasia.Conclusions There is a high incidence of fetal abnormality and perinatal mortality in MCMA twin pregnancy.Accurate early diagnosis,enhanced management and mon让oring during pregnancy,and individualized treatment are the keys to improve MCMA twin pregnancy outcomes.

关 键 词：妊娠 双胎 单绒毛膜单羊膜囊双胎 胎儿监测 妊娠结局 

分 类 号：R714.23[医药卫生—妇产科学]