CAJ | 학술논문

目的探讨提示单绒毛膜双胎合并一胎选择性生长受限(selective fetal growth restriction,sFGR)胎儿宫内死亡或新生儿期死亡的超声征象. 方法研究对象为2005年1月至2010年5月在本院行产前超声检查发现的单绒毛膜双胎合并一胎sFGR病例,均采用期待疗法并随访分娩结局.记录以下超声指标:sFGR胎儿脐动脉血流频谱异常、大胎羊水过多、sFGR胎儿羊水过少、双胎估计胎儿体重的差异百分数、脐带帆状附着及诊断孕周.应用Logistic回归分析各超声指标与sFGR胎儿发生死亡的相关性. 结果共诊断51例单绒毛膜双胎合并一胎sFGR,其中11例(21.6％)sFGR胎儿死亡,包括4例官内死亡和7例新生儿期死亡;双胎均死亡3例(5.9％).Logistic回归分析发现,sFGR胎儿出现羊水过少(OR=22.80,95％CI:3.58～145.31,P=0.001)和脐动脉血流频谱异常(OR=6.51,95％CI:1.16～36.53,P=0.033)是sFGR胎儿官内死亡或新生儿期死亡的独立危险因素. 结论 sFGR胎儿脐动脉舒张末期血流频谱异常和羊水过少均提示预后不良.
목적 탐토제시단융모막쌍태합병일태선택성생장수한(selective fetal growth restriction,sFGR)태인궁내사망혹신생인기사망적초성정상. 방법 연구대상위2005년1월지2010년5월재본원행산전초성검사발현적단융모막쌍태합병일태sFGR병례,균채용기대요법병수방분면결국.기록이하초성지표:sFGR태인제동맥혈류빈보이상、대태양수과다、sFGR태인양수과소、쌍태고계태인체중적차이백분수、제대범상부착급진단잉주.응용Logistic회귀분석각초성지표여sFGR태인발생사망적상관성. 결과 공진단51례단융모막쌍태합병일태sFGR,기중11례(21.6％)sFGR태인사망,포괄4례관내사망화7례신생인기사망;쌍태균사망3례(5.9％).Logistic회귀분석발현,sFGR태인출현양수과소(OR=22.80,95％CI:3.58～145.31,P=0.001)화제동맥혈류빈보이상(OR=6.51,95％CI:1.16～36.53,P=0.033)시sFGR태인관내사망혹신생인기사망적독립위험인소. 결론 sFGR태인제동맥서장말기혈류빈보이상화양수과소균제시예후불량.
Objective To investigate the ultrasonographic indicators predicting the outcomes of selective fetal growth restriction (sFGR) fetuses in monochorionic twins under expectant management. Methods Monochorionic twins with sFGR diagnosed in the First Affiliated Hospital of SUN Yat-sen University from Jan.2005 to May 2010 were included into this study.All patients underwent expectant treatment.Ultrasound appearances of monochorionic twins were documented in detail when sFGR was diagnosed.At the initial evaluation,presence or absence of the following abnormalities were documented, including abnormal Doppler flow in the umbilical artery,polyhydramnios in the larger twin,oligohydramnios,fetal weight discordance and velamentous cord insertion in sFGR fetuses; gestational age at diagnosis was recorded as well.The relationship between these ultrasound characteristics and mortality of sFGR fetus was analyzed with Logistic regression.Results Of 51 sFGR fetuses,11 (21.6％) suffered from fetal death,including four intrauterine demise and seven neonatal deaths both twins were dead in 3 cases. Logistic regression analysis demonstrated that oligohydramnios (OR=22.80,95％CI:3.58-145.31,P=0.001) and abnormality of diastolic flow in the umbilical artery (OR=6.51,95％CI:1.16-36.53,P=0.033) were independent risk factors of mortality of sFGR fetuses. Conclusions Both oligohydramnios and abnormal Doppler flow in the umbilical artery suggest poor prognosis of sFGR fetuses in monochorionic twins.