53例双胎妊娠一胎畸形临床分析  

Clinical analysis of 53 cases of twin pregnancy with one fetal malformation

作　　者：李馨 耿力[1] LI Xin;GENG Li(Department of Obstetric,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：《中国优生与遗传杂志》2021年第8期1106-1110,共5页Chinese Journal of Birth Health & Heredity

摘　　要：目的探讨双胎妊娠一胎畸形的临床特点、孕期管理及妊娠结局。方法分析2016年1月至2020年7月于昆明医科大学第一附属医院产科分娩的53例双胎妊娠一胎畸形的临床资料,根据绒毛膜性分为单绒毛膜(monochorionic,MC)双胎组(21例)和双绒毛膜(dichorionic,DC)双胎组(32例);根据治疗方案分为终止妊娠组(5例)、期待治疗组(31例)、选择性减胎组(17例)。结果MC双胎组心血管系统畸形占比(66.7%)显著大于DC双胎组(31.3%)(P<0.05);DC双胎组神经系统畸形占比(37.5%)显著大于MC双胎组(9.5%)(P<0.05)。期待治疗组非畸形儿早产率显著大于选择性减胎组(P<0.05);两组间新生儿窒息、转新生儿重症监护室及死亡发生率、剖宫产率及产钳助产率、出生体质量差异无统计学意义(P>0.05)。期待治疗组胎膜早破及产后出血发生率显著高于减胎组(P<0.05),两组间妊娠期高血压疾病、妊娠期糖尿病、妊娠期肝内胆汁淤积综合征发生率差异无统计学意义(P>0.05)。结论产前筛查是预防严重缺陷儿出生的一道关键防线。规范双胎产前筛查,加强遗传咨询和产前诊断,多学科共同讨论母儿预后,制定个体化诊疗方案,有助于改善孕妇及围生儿结局。Objective To explore the clinical features,pregnancy management and pregnancy outcome of twin pregnancy with one fetus malformation.Methods The clinical data of 53 cases of twin pregnancy and one fetus malformation delivered in the First Affiliated Hospital of Kunming Medical University from January 2016 to July 2020 were retrospectively analyzed.According to chorionic property,they were divided into monochorionic(MC)twin group(21 cases)and dichorionic(DC)twin group(32 cases).According to the therapeutic regimen,they were divided into termination of pregnancy group(5 cases),expectation treatment group(31 cases)and selective reduction group(17 cases).Results The proportion of cardiovascular system malformations in MC twin group(66.7%)was higher than that in DC twin group(31.3%)significantly(P<0.05).The proportion of nervous system malformations(37.5%)in the DC twins group was higher than that in the MC twins group(9.5%)significantly(P<0.05).The preterm rate of non-deformed infants in the expectation treatment group was higher than that in the selective reduction group significantly(P<0.05).There was no significant difference in neonatal asphyxia,transfer to NICU,death rate,cesarean section rate,forceps delivery rate and birth weight between the two groups(P>0.05).The incidence of premature rupture of membranes and postpartum hemorrhage in the expectant treatment group were higher than that in the fetal reduction group significantly(P<0.05).There was no significant difference in the incidence of hypertensive disorder complicating pregnancy,gestational diabetes mellitus and intrahepatic cholestasis of pregnancy between the two groups(P>0.05).Conclusion Prenatal screening is a key line of defense against severe birth defects.Standardizing prenatal screening of twins,strengthening genetic counseling and prenatal diagnosis,multidisciplinary discussion of maternal and fetal prognosis,and formulating individualized diagnosis and treatment plan are conducive to improving maternal and perinatal outcomes.

关 键 词：双胎妊娠 畸形 产前诊断 选择性减胎 

分 类 号：R714.23[医药卫生—妇产科学] R714.53[医药卫生—临床医学]