单绒毛膜双胎妊娠的围产结局分析
단융모막쌍태임신적위산결국분석
Perinatal outcome of monochorionic twin pregnancies
  • 万方数据
    中华妇产科杂志 중화부산과잡지
    CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
    2013年 6期 405-410 ,共6页

    余海燕%刘子建%Daljit S.Sahota%丁婉霞%梁德杨

    여해연%류자건%Daljit S.Sahota%정완하%량덕양

    双生,单绒毛膜%双胎输血综合征%胎儿生长受限%出生体重%妊娠结局 雙生,單絨毛膜%雙胎輸血綜閤徵%胎兒生長受限%齣生體重%妊娠結跼
    쌍생,단융모막%쌍태수혈종합정%태인생장수한%출생체중%임신결국
    Twins,monochorionic%Fetofetal transfusion%Fetal growth retardation%Birth weight%Pregnancy outcome
    目的 探讨单绒毛膜(MC)双胎妊娠的围产结局.方法 2005年1月-2010年12月在香港中文大学威尔斯亲王医院产前检查并分娩的MC双胎妊娠孕妇197例,分为无并发症组(136例)、双胎输血综合征(TTTS)组(32例)及选择性宫内生长受限(sIUGR)组(29例),对各组孕妇的基本资料、产科并发症、胎儿超声检查结果及围产结局进行分析与比较.结果 (1)分娩孕周及活产儿数:TTTS组、sIUGR组孕妇分娩孕周(分别为孕30周、34周)及活产儿数(分别为36、47例)均显著低于无并发症组(分别为孕37周、261例),差异均有统计学意义(P＜0.01).(2)死胎:TTTS组、sIUGR组死胎发生率[分别为34％(11/32)、28％(8/29)]均显著高于无并发症组[4％ (6/136)],分别比较,差异均有统计学意义(P＜0.01).(3)双胎出生体质量差异＞ 25％:TTTS组、sIUGR组双胎儿出生体质量差异＞25％的发生率[分别为5/15、33％ (7/21)]均显著高于无并发症组[7.7％(10/130)],分别比较,差异均有统计学意义(P＜0.05).(4)早产:sIUGR组早产发生率[69％(20/29)]显著高于无并发症组[49％(66/136)],差异有统计学意义(P＜0.05).(5)围产儿死亡:无并发症组、TTTS组、sIUGR组围产儿死亡分别为1例(0.4％,1/262)、5例(12％,5/41)、5例(10％,5/52),TTTS组及sIUGR组围产儿死亡率均显著高于无并发症组,差异均有统计学意义(P＜0.01).(6)双胎儿估计体质量(EFW)差异＞25％:无并发症组23例(17％,23/136),sIUGR组15例(52％,15/29),TTTS组20例(63％,20/32),sIUGR组及TTTS组双胎EFW差异＞25％发生率明显高于无并发症组.无并发症组、sIUGR组中EFW差异＞25％者分娩孕周均明显低于同组中EFW差异≤25％者(P＜0.05),两组中EFW差异＞25％时早产率、新生儿ICU(NICU)入住率均显著高于同组中EFW差异≤25％者(P＜0.05),无并发症组EFW差异＞25％时新生儿窒息率显著升高(P＜0.05).(7)脐动脉血流多普勒监测异常:无并发症组13例(9.6％,13/136)发生异常,TTTS组12例(38％,12/32)异常,sIUGR组12例(41％,12/29)异常,TTTS组、sIUGR组脐动脉血流异常发生率明显高于无并发症组,差异均有统计学意义(P＜0.01).脐动脉血流异常者死胎发生率在无并发症组、TTTS组、sIUGR组分别为2/13、6/12、5/12.结论 MC双胎并发TTTS、sIUGR者不良围产结局发生率高于无并发症MC双胎；双胎儿EFW差异＞25％者不良围产结局发生率增加；脐动脉血流多普勒监测异常与MC双胎妊娠结局相关.
    목적 탐토단융모막(MC)쌍태임신적위산결국.방법 2005년1월-2010년12월재향항중문대학위이사친왕의원산전검사병분면적MC쌍태임신잉부197례,분위무병발증조(136례)、쌍태수혈종합정(TTTS)조(32례)급선택성궁내생장수한(sIUGR)조(29례),대각조잉부적기본자료、산과병발증、태인초성검사결과급위산결국진행분석여비교.결과 (1)분면잉주급활산인수:TTTS조、sIUGR조잉부분면잉주(분별위잉30주、34주)급활산인수(분별위36、47례)균현저저우무병발증조(분별위잉37주、261례),차이균유통계학의의(P＜0.01).(2)사태:TTTS조、sIUGR조사태발생솔[분별위34％(11/32)、28％(8/29)]균현저고우무병발증조[4％ (6/136)],분별비교,차이균유통계학의의(P＜0.01).(3)쌍태출생체질량차이＞ 25％:TTTS조、sIUGR조쌍태인출생체질량차이＞25％적발생솔[분별위5/15、33％ (7/21)]균현저고우무병발증조[7.7％(10/130)],분별비교,차이균유통계학의의(P＜0.05).(4)조산:sIUGR조조산발생솔[69％(20/29)]현저고우무병발증조[49％(66/136)],차이유통계학의의(P＜0.05).(5)위산인사망:무병발증조、TTTS조、sIUGR조위산인사망분별위1례(0.4％,1/262)、5례(12％,5/41)、5례(10％,5/52),TTTS조급sIUGR조위산인사망솔균현저고우무병발증조,차이균유통계학의의(P＜0.01).(6)쌍태인고계체질량(EFW)차이＞25％:무병발증조23례(17％,23/136),sIUGR조15례(52％,15/29),TTTS조20례(63％,20/32),sIUGR조급TTTS조쌍태EFW차이＞25％발생솔명현고우무병발증조.무병발증조、sIUGR조중EFW차이＞25％자분면잉주균명현저우동조중EFW차이≤25％자(P＜0.05),량조중EFW차이＞25％시조산솔、신생인ICU(NICU)입주솔균현저고우동조중EFW차이≤25％자(P＜0.05),무병발증조EFW차이＞25％시신생인질식솔현저승고(P＜0.05).(7)제동맥혈류다보륵감측이상:무병발증조13례(9.6％,13/136)발생이상,TTTS조12례(38％,12/32)이상,sIUGR조12례(41％,12/29)이상,TTTS조、sIUGR조제동맥혈류이상발생솔명현고우무병발증조,차이균유통계학의의(P＜0.01).제동맥혈류이상자사태발생솔재무병발증조、TTTS조、sIUGR조분별위2/13、6/12、5/12.결론 MC쌍태병발TTTS、sIUGR자불량위산결국발생솔고우무병발증MC쌍태；쌍태인EFW차이＞25％자불량위산결국발생솔증가；제동맥혈류다보륵감측이상여MC쌍태임신결국상관.
    Objective To study the perinatal outcome of monochorionic (MC) twin pregnancies.Methods The 197 cases of MC twin pregnancies delivered in obstetric unit of Prince of Wales Hospital from Jan.2005 to Dec.2010 were enrolled in this retrospective study,which were divided into 3 groups:uncomplicated MC pregnancy (136 cases),twin to twin transfusion syndrome (TTTS,32 cases),selective intrauterine growth restriction (sIUGR,29 cases).Results (1)The gestational age at delivery in TTTS (30 weeks vs.37 weeks,P ＜0.01) or sIUGR (34 weeks vs.37 weeks,P ＜0.01) group were significantly lower than those in uncomplicated MC pregnancy.The number of live-born in TTTS (36 cases)or sIUGR (47 cases) group were significantly lower than those in uncomplicated MC pregnancy (261 cases,P ＜0.01).(2) The incidence of fetal death (IUFD) in TTTS [34％ (11/32) vs.4％ (6/136),P ＜0.01]or sIUGR group [28％ (8/29) vs.4％ (6/136),P ＜0.01] were significantly higher than those in uncomplicated MC pregnancy group.(3) The incidence of birth weight (BW) disc ordance ＞ 25％ in TTTS [5/15 vs.7.7％ (10/130),P ＜0.05] or sIUGR[33％ (7/21) vs.7.7％ (10/130),P ＜0.05] group were significantly higher than those in uncomplicated MC pregnancy group.(4) The incidence of preterm delivery before 37 weeks was 49％ (66/136) and 69％ (20/29) respectively in uncomplicated MC pregnancy and sIUGR.The incidence of preterm delivery in sIUGR group were significantly higher than that in uncomplicated MC pregnancy group (P ＜ 0.05).(5) The incidence of perinatal mortality in TTTS [12％(5/41) vs.0.4％ (1/262),P ＜0.01] or sIUGR[10％ (5/52) vs.0.4％ (1/262),P ＜0.01] group were significantly higher than those in uncomplicated MC pregnancy group.(6) The incidence of estimated fetal weight (EFW) discordance ＞25％ was 17％ (23/136) in uncomplicated MC pregnancy,52％ (15/29) in sIUGR,63％ (20/32) in TTTS.In uncomplicated MC pregnancy or sIUGR,pregnancies with EFW discordance ＞25％ was associated with lower gestational age at delivery,higher incidence of preterm delivery and admission to NICU than those with EFW discordance ≤ 25％ (P ＜ 0.05).In uncomplicated MC pregnancy,pregnancies with EFW discordance ＞ 25％ was associated with higher incidence of neonatal asphyxia (Apgar score 1 minute ≤7) than those with EFW discordance≤25％ (P ＜0.05).(7) Compared to uncomplicated MC pregnancy,the incidence of umbilical artery (UmA) flow abnormality was higher in TTTS[38％(12/32) vs.9.6％(13/136),P＜0.01]or sIUGR[41％(12/29) vs.9.6％(13/136),P＜0.01].The incidence of IUFD in pregnacies with UmA flow abnormality was 2/13,6/12 and 5/12 respectively in uncomplicated MC pregnancy,TTTS and sIUGR.Conclusions MC pregnancies complicated by either TTTS or sIUGR have poorer perinatal outcome as compared with uncomplicated MC pregnancies.MC pregnancies with EFW discordance ＞ 25％ and UmA flow abnormality are associated with even worse perinatal outcome.Close fetal monitoring is needed in MC pregnancies in order to reduce perinatal mortality.
    원문보기 원문다운로드 사이트로이동
저자의 최근 논문