含单绒毛膜多胎妊娠的产前管理  

Prenatal management of multifetal pregnancies containing monochorionic fetuses

作　　者：王燕芸 王谢桐 Wang Yanyun;Wang Xietong(Department of Obstetrics and Gynecology,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,China;Key Laboratory of Birth Regulation and Control Technology of National Health Commission,Jinan 250014,China)

机构地区：[1]山东第一医科大学附属省立医院妇产科,济南250021 [2]国家卫生健康委员会生育调控技术重点实验室,济南250014

出　　处：《中华围产医学杂志》2021年第4期245-248,共4页Chinese Journal of Perinatal Medicine

基　　金：国家重点研发计划(2018YFC1002900、2018YFC1002903)。

摘　　要：含单绒毛膜的多胎妊娠情况复杂,孕妇的孕期监测及宫内干预尤为重要。含单绒毛膜双胎的双绒毛膜三羊膜囊三胎妊娠可以在孕11~14周采用氯化钾心脏注射减去同绒毛膜双胎之一,保留单绒毛膜单胎,也可以选择孕16周后射频消融减胎术保留双绒毛膜双羊膜囊双胎,2种减胎方式妊娠结局无明显差异。胎儿镜激光手术能显著改善多胎妊娠合并双胎输血综合征的妊娠结局。在含单绒毛膜单羊膜囊双胎的三胎妊娠减胎时,可以采用脐带闭塞和离断技术以避免脐带缠绕造成的胎儿死亡。三绒毛膜四羊膜囊四胎妊娠减胎时宜采用氯化钾心脏注射减去同绒毛膜囊内2个胎儿。含单绒毛膜三胎或四胎妊娠可以选择性减胎,但研究样本量较少,临床需要充分咨询,个体化选择治疗方式。Multifetal pregnancies with monochorionicity are more complicated,for which pregnancy monitoring and intrauterine intervention are of great importance.For dichorionic triamniotic triplets with MC twin,multifetal pregnancy reduction measures included cardiac injection of potassium chloride at 11 to 14 weeks of gestation for reduction to monochorionic singleton,and radiofrequency ablation after 16 weeks of gestation to preserve the dichorionic diamniotic twins.Moreover no significant difference was observed in the pregnancy outcomes between the two methods.Fetalscopic laser surgery can significantly improve the perinatal prognosis of multiple pregnancies complicated by twin-to-twin transfusion syndrome.Umbilical occlusion and transection can be used for the reduction of triplets containing monochorionic monoamniotic twins to avoid fetal death caused by entanglement of the umbilical cord.Cardiac injection of potassium chloride is appropriate for reducing the two fetuses in the same chorionic sac for trichorionic quadruamniotic pregnancy.Selective fetal reduction is applicable for MC triplets or quadruplets pregnancy,however,relevant studies are all with a small sample size,which requires full consultation and individualized treatment.

关 键 词：妊娠 多胎 单绒毛膜双胎/多胎 选择性减胎术 减胎方法 

分 类 号：R714.23[医药卫生—妇产科学]