中华围产医学杂志
中華圍產醫學雜誌
중화위산의학잡지
CHINESE JOURNAL OF PERINATAL MEDICINE
2014年
9期
609-613
,共5页
邵长香%孙路明%邹刚%孙琦%周奋翮%周艳
邵長香%孫路明%鄒剛%孫琦%週奮翮%週豔
소장향%손로명%추강%손기%주강핵%주염
双生,单绒毛膜%超声检查,产前%胎儿监测%妊娠结局
雙生,單絨毛膜%超聲檢查,產前%胎兒鑑測%妊娠結跼
쌍생,단융모막%초성검사,산전%태인감측%임신결국
Twin,monochorionic%Ultrasonography,prenatal%Fetal monitoring%Pregnancy outcome
目的 总结单绒毛膜单羊膜囊(monochorionic monoamniotic,MCMA)双胎妊娠的诊断、妊娠期监护、处理及妊娠结局. 方法 2010年7月至2013年8月共1 7例MCMA双胎妊娠孕妇在同济大学附属第一妇婴保健院接受产前检查并分娩.明确诊断的MCMA双胎根据具体情况采取引产、选择性减胎术及期待妊娠3种处理方式.选择期待妊娠的MCMA孕妇每2周1次定期随访;28周促胎肺成熟;28～30周入院监测:每日连续40 min胎儿电子监护,每周监测脐血流2次;30～32周:每日2次连续40 min胎儿电子监护,隔日行脐血流监测;32～34周:每日至少3次连续40 min胎儿电子监护,每日行脐血流及生物物理学评分检查,适时终止妊娠.总结合并脐带缠绕、胎儿先天性畸形、胎死宫内、单绒毛膜双胎妊娠特殊并发症(如选择性胎儿生长受限、双胎反向动脉灌注序列征及双胎输血综合征)情况及妊娠结局. 结果 17例MCMA双胎孕妇平均年龄为(29.0±2.7)岁(24～33岁),均为初产妇,平均诊断MCMA的孕周为(18.6±5.5)周(11 +5～28+1周).1 7例MCMA双胎孕妇产前超声均提示脐带缠绕,且均得到产后证实.并发胎儿畸形7例,发生单绒毛膜双胎妊娠特殊并发症3例,其中双胎反向动脉灌注序列征1例,选择性胎儿生长受限2例.7例并发胎儿畸形孕妇中的4例选择引产;1例并发胎儿之一无脑畸形孕妇行射频消融减胎术.另2例并发胎儿畸形者和10例无胎儿畸形的孕妇均选择期待妊娠,期间超声均无异常提示.但其中2例分别于妊娠16和21+1周超声监测发现2胎儿均胎死宫内,行引产术;1例住院监测期间妊娠30+2周发生一胎胎死宫内,急诊剖宫产终止妊娠.共11例孕妇活产分娩,平均于(32.7±1.6)周行剖宫产.其中4例考虑脐带因素急诊手术分娩.活产新生儿共20例,平均出生体重为(1 850±496)g.1 6例新生儿转新生儿重症监护病房,平均人住(37.9±16.4)d;9例新生儿发生呼吸窘迫综合征,均治愈. 结论 MCMA双胎妊娠围产儿发病率及病死率高,妊娠早期超声检查有助于明确诊断及加强监护和管理,并改善妊娠结局.
目的 總結單絨毛膜單羊膜囊(monochorionic monoamniotic,MCMA)雙胎妊娠的診斷、妊娠期鑑護、處理及妊娠結跼. 方法 2010年7月至2013年8月共1 7例MCMA雙胎妊娠孕婦在同濟大學附屬第一婦嬰保健院接受產前檢查併分娩.明確診斷的MCMA雙胎根據具體情況採取引產、選擇性減胎術及期待妊娠3種處理方式.選擇期待妊娠的MCMA孕婦每2週1次定期隨訪;28週促胎肺成熟;28～30週入院鑑測:每日連續40 min胎兒電子鑑護,每週鑑測臍血流2次;30～32週:每日2次連續40 min胎兒電子鑑護,隔日行臍血流鑑測;32～34週:每日至少3次連續40 min胎兒電子鑑護,每日行臍血流及生物物理學評分檢查,適時終止妊娠.總結閤併臍帶纏繞、胎兒先天性畸形、胎死宮內、單絨毛膜雙胎妊娠特殊併髮癥(如選擇性胎兒生長受限、雙胎反嚮動脈灌註序列徵及雙胎輸血綜閤徵)情況及妊娠結跼. 結果 17例MCMA雙胎孕婦平均年齡為(29.0±2.7)歲(24～33歲),均為初產婦,平均診斷MCMA的孕週為(18.6±5.5)週(11 +5～28+1週).1 7例MCMA雙胎孕婦產前超聲均提示臍帶纏繞,且均得到產後證實.併髮胎兒畸形7例,髮生單絨毛膜雙胎妊娠特殊併髮癥3例,其中雙胎反嚮動脈灌註序列徵1例,選擇性胎兒生長受限2例.7例併髮胎兒畸形孕婦中的4例選擇引產;1例併髮胎兒之一無腦畸形孕婦行射頻消融減胎術.另2例併髮胎兒畸形者和10例無胎兒畸形的孕婦均選擇期待妊娠,期間超聲均無異常提示.但其中2例分彆于妊娠16和21+1週超聲鑑測髮現2胎兒均胎死宮內,行引產術;1例住院鑑測期間妊娠30+2週髮生一胎胎死宮內,急診剖宮產終止妊娠.共11例孕婦活產分娩,平均于(32.7±1.6)週行剖宮產.其中4例攷慮臍帶因素急診手術分娩.活產新生兒共20例,平均齣生體重為(1 850±496)g.1 6例新生兒轉新生兒重癥鑑護病房,平均人住(37.9±16.4)d;9例新生兒髮生呼吸窘迫綜閤徵,均治愈. 結論 MCMA雙胎妊娠圍產兒髮病率及病死率高,妊娠早期超聲檢查有助于明確診斷及加彊鑑護和管理,併改善妊娠結跼.
목적 총결단융모막단양막낭(monochorionic monoamniotic,MCMA)쌍태임신적진단、임신기감호、처리급임신결국. 방법 2010년7월지2013년8월공1 7례MCMA쌍태임신잉부재동제대학부속제일부영보건원접수산전검사병분면.명학진단적MCMA쌍태근거구체정황채취인산、선택성감태술급기대임신3충처리방식.선택기대임신적MCMA잉부매2주1차정기수방;28주촉태폐성숙;28～30주입원감측:매일련속40 min태인전자감호,매주감측제혈류2차;30～32주:매일2차련속40 min태인전자감호,격일행제혈류감측;32～34주:매일지소3차련속40 min태인전자감호,매일행제혈류급생물물이학평분검사,괄시종지임신.총결합병제대전요、태인선천성기형、태사궁내、단융모막쌍태임신특수병발증(여선택성태인생장수한、쌍태반향동맥관주서렬정급쌍태수혈종합정)정황급임신결국. 결과 17례MCMA쌍태잉부평균년령위(29.0±2.7)세(24～33세),균위초산부,평균진단MCMA적잉주위(18.6±5.5)주(11 +5～28+1주).1 7례MCMA쌍태잉부산전초성균제시제대전요,차균득도산후증실.병발태인기형7례,발생단융모막쌍태임신특수병발증3례,기중쌍태반향동맥관주서렬정1례,선택성태인생장수한2례.7례병발태인기형잉부중적4례선택인산;1례병발태인지일무뇌기형잉부행사빈소융감태술.령2례병발태인기형자화10례무태인기형적잉부균선택기대임신,기간초성균무이상제시.단기중2례분별우임신16화21+1주초성감측발현2태인균태사궁내,행인산술;1례주원감측기간임신30+2주발생일태태사궁내,급진부궁산종지임신.공11례잉부활산분면,평균우(32.7±1.6)주행부궁산.기중4례고필제대인소급진수술분면.활산신생인공20례,평균출생체중위(1 850±496)g.1 6례신생인전신생인중증감호병방,평균인주(37.9±16.4)d;9례신생인발생호흡군박종합정,균치유. 결론 MCMA쌍태임신위산인발병솔급병사솔고,임신조기초성검사유조우명학진단급가강감호화관리,병개선임신결국.
Objective To review the diagnosis,monitoring,management and perinatal outcomes of monochorionic monoamniotic (MCMA) twin pregnancy.Methods From July 2010 to August 2013,there were 17 MCMA twin pregnancies diagnosed and delivered in Shanghai First Maternity and Infant Hospital.According to the MCMA management protocol,induced abortion,elective fetal reduction,and anticipant pregnancy were optional.For those anticipant pregnancies,fetal lung underwent maturation promotion at gestational weeks 28; hospitalization with 40 min/day continual fetal electronic monitoring and umbilical blood monitoring twice weekly at gestational weeks 28-30; 40 min continual fetal electronic monitoring twice daily and umbilical blood monitoring once every other day at gestational weeks 30-32; and 40 min continual fetal electronic monitoring three times daily and umbilical blood monitoring once daily at gestational weeks 32-34; and pregnancy ended on time.The presence of umbilical cord entanglement,congenital malformation,intrauterine fetal death,complications exclusive to monochorionic twins (e.g.selective fetal growth restriction,twin reversed arterial perfusion sequence and twin-twin transfusion syndrome) and the perinatal outcomes were retrospectively analyzed.Results Average maternal age of women with 17 MCMA twins was (29.0±2.7) years,and all were primiparas.They were diagnosed at (18.6± 5.5) weeks on average (11 +5-28+1 weeks).Umbilical cord entanglements were detected in all cases by ultrasonography and confirmed postnatally.There were three cases of complications specific to monochorionic twins,including two with selective fetal growth restriction and one with twin reversed arterial perfusion sequence.There were seven women with fetal congenital malformation; four of whom chose induced abortion; one case of anencephaly chose radiofrequency ablation fetal reduction,and the remaining two cases with congenital malformation and ten cases without chose anticipant pregnancy,and there were no abnormal ultrasonography signs during pregnancy.Among these 12 cases,intrauterine fetal death of both fetuses occurred in two cases at 16 and 21+1 weeks gestation and they were aborted.Intrauterine fetal death of a single fetus occurred in one case at 30+2 weeks gestation (another fetus was delivered by emergency cesarean section).There were a total of eleven live births delivered by cesarean section (four by emergency cesarean section) at a median gestational age of (32.7± 1.6) weeks.There were 20 live neonates with a mean birth weight of (1 850±496) g.Sixteen neonates were transferred to the neonatal intensive care unit and hospitalized for (37.9± 16.4) days.Nine neonates suffered from respiratory distress syndrome but were eventually cured.Conclusions MCMA twin pregnancy has high morbidity and mortality.Early ultrasonography helps to clarify the diagnosis and enhance the monitoring,thus improving the perinatal outcomes.
