双胎妊娠早产的早期预测与临床处理  

Early prediction and clinical management of preterm birth in twin pregnancies

作　　者：胡晓雨 邹刚[1] HU Xiao-yu;ZOU Gang(Department of Fetal Medicine,Shanghai First Maternity and Infant Hospital,Obstetrics and Gynecology Hospital Affiliated to Tongji University,Shanghai 201204,China)

机构地区：[1]上海市第一妇婴保健院/同济大学附属妇产科医院胎儿医学科,上海201204

出　　处：《中国实用妇科与产科杂志》2025年第2期161-166,共6页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：国家重点研发计划(2023YFC2705900;2022YFC2704700)。

摘　　要：早产是双胎妊娠最常见的并发症。单绒毛膜双胎、既往早产史、子宫颈手术史、高龄等是双胎妊娠早产的高危因素。孕中期经阴道子宫颈管长度测量是双胎自发性早产的最佳预测因子,无症状双胎伴短子宫颈时,胎儿纤维链接蛋白(fFN)及羊水淤泥样沉积物筛查可能具额外预测价值。双胎妊娠早产风险的临床管理需详细评估病史,建议个性化管理,定期产前检查及超声监测子宫颈管长度及胎儿宫内情况,单绒毛膜双羊膜囊双胎应重点关注双胎输血综合征(TTTS)、选择性胎儿生长受限(sFGR)等并发症。孕激素阴道给药对子宫颈长度≤25 mm的双胎妊娠早产的预防可能有益,但疗效需更多高质量随机对照试验(RCT)验证。子宫颈环扎术不推荐常规用于双胎妊娠,紧急环扎术在子宫颈极短并伴有扩张时可能有益。临床决策应综合患者具体情况及最新研究进展考虑。Preterm birth is the most common complication in twin pregnancies. Monochorionic twins,history of previous preterm birth,history of cervical surgery and advanced maternal age have been shown to be correlated with a higher risk of preterm birth in twin pregnancies. Transvaginal cervical length measurement during the second trimester is the best predictor for spontaneous preterm birth in twin pregnancies. For asymptomatic twin pregnancies with short cervix,fetal fibronectin(FFN) and amniotic fluid sludge screening may have additional predictive value. Clinical management of the risk of preterm birth in twins requires a detailed assessment of medical history and personalized management,including regular prenatal check-ups and ultrasound monitoring of cervical length and fetal conditions. Monochorionic diamniotic twins should be closely monitored for complications such as twin-to-twin transfusion syndrome(TTTS)and selective intrauterine growth restriction(sIUGR). Vaginal progesterone may be beneficial in preventing preterm birth in twin pregnancies with cervical length ≤25mm,but its efficacy needs further validation by high-quality randomized controlled trials. Routine use of cervical cerclage is not recommended for twin pregnancies,although emergency cerclage may be beneficial when the cervix is extremely short and accompanied by dilation. Clinical decisions should take specific conditions of patients and the latest research developments into account.

关 键 词：双胎妊娠 早产 子宫颈长度 子宫颈环扎 孕酮 

分 类 号：R714.23[医药卫生—妇产科学]