摘要
目的：探讨单羊膜（MA）双胎的临床特征及围生结局。方法：回顾性分析2007～2012年北京大学第三医院流产及分娩的17例MA双胎的临床资料。结果：①17例MA双胎中孕早、中期流产或引产4例（23．5％）：1例一胎儿无脑儿、一胎儿胚胎停育流产，1例发生双胎输血综合征（1_ITI’S）引产，2例发生无心畸胎（TRAP）引产。另2例TRAP于孕23周行胎儿镜脐带结扎减胎术后继续妊娠。②MA双胎进入围生期13例（76．5％），分娩中位孕周33周，其中规律产前检查9例，无规律产前检查4例。13例中无合并症入院待产择期剖宫产3例（存活新生儿5例）；因胎膜早破、先兆早产和胎儿窘迫入院6例，其中行急诊剖宫产4例，自然分娩2例，存活新生儿10例；并发重度子痫前期2例，其中急诊剖宫产1例，择期剖宫产1例，存活新生儿4例；合并TRAP1例孕39周自然分娩，存活新生儿1例；孕30周双胎胎死宫内引产1例。③胎儿畸形9例（26．5％，9／34），其中TRAP4例，无脑儿2例，先天性心脏病1例，肛门闭锁1例，先天性面横裂1例。结论：MA双胎胎儿畸形发生率高，早产风险大，孕期规律产前检查，积极进行TRAP、TTIS、重度子痫前期等处理，必要时入院待产，及时行剖宫产术可改善妊娠结局。
Objective：To study the clinical features and perinatal outcomes of monoamniotic twins. Meth- ods：The clinical data of 17 cases of monoamniotic twin pregnancy who admitted in Peking University third hospital between 2007 and 2012 were retrospectively analyzed. Results：（1）Among the 17 cases of monoam- niotic twin pregnancy,4 cases abortion or induced labour：l case abortion because of anencephaly and em- bryo damage;other cases received induced labour,2 with twin reversed artery perfusion sequence, 1 with twin-twin transfusion syndrome. There are other two cases with twin reversed artery perfusion sequence, which recevied fetoscopic surgery. （2）13 cases reached the perinatal period （76.5%） ,9 cases with regular antenatal examination,4 cases with irregular antenatal examination, media delivery gestational age was 33 weeks. 3 cases with no complication admitted to hospital for elective cesarean （5 newborns alive） ;6 cases with premature rupture of membranes,threatened preterm birth or fetal distress admitted to hospital,4 cases received emergency cesarean,2 cases delivered naturally（10 newborns alive） ;2 cases complicated with se- vere preeclampsia received emergency cesarean（4 newborns alive） ;t cases complicated with twin reversed arterial perfusion sequence delivered naturally in 39 weeks（1 newborns alive） ;1 case with intrauterine fetal death received induced labour. （3）9 cases with fetal abnormality（26.5% ,9/34）,4 cases with twin reversed artery perfusion sequence,2 cases with anencephaly,1 case with congenital heart disease,1 case with im- perforate anus,1 case with congenital surface transverse crack. Conclusions： Because of high risk of fetal deformity and premature labor in monoamniotic twins, regular antenatal examination,active treatment of twin reversed arterial perfusion sequence, twin-twin transfusion syndrome and severe preeclampsia, appropriate admission, and timely cesarean can improve pregnancy outcomes.
出处
《实用妇产科杂志》
CAS
CSCD
北大核心
2014年第3期227-230,共4页
Journal of Practical Obstetrics and Gynecology
关键词
单羊膜
双胎
双胎输血综合征
无心畸胎
Monoamniotic
Twins
Twin-twin transfusion syndrome
Twin reversed arterial perfusion se- quence
作者简介
通讯作者：赵扬玉，Email：yangyuzha00507@126．com
