CAJ | 학술논문

目的探讨妊娠中晚期双绒毛膜双羊膜囊双胎(dichorionic diamniotic twin,DCDA)妊娠一胎染色体非整倍体进行氯化钾选择性减胎术的策略和妊娠结局. 方法 2008年6月1日至2012年12月30日在中山大学附属第一医院妇产科胎儿医学中心就诊的DCDA孕妇20例,产前诊断一胎染色体非整倍体,另一胎核型正常,于妊娠14～34周对异常胎儿实施心脏注射氯化钾减胎术.分析术后流产、胎膜早破、早产等并发症及新生儿结局. 结果孕妇平均年龄为(33.8±4.3)岁,平均减胎孕周为(23.4±5.8)周,≤妊娠20周减胎6例、21～27周减胎8例、≥28周减胎6例.1 7例被减胎有畸形等明显减胎标记,3例仅有超声软指标或胎儿位置差别等弱减胎标记.20例均减胎成功,20％(4/20)术后流产,35％(7/20)早产,45％(9/20)足月分娩,总体新生儿存活率为65％ (13/20),无一例发生宫内感染.近宫颈胎儿和远离宫颈胎儿减胎后未足月胎膜早破发生率分别为7/12和0/8. 结论对妊娠中晚期DCDA一胎染色体非整倍体进行氯化钾选择性减胎术,母体安全,减胎成功率高.减灭近宫颈的胎儿时,未足月胎膜早破发生率高.
목적 탐토임신중만기쌍융모막쌍양막낭쌍태(dichorionic diamniotic twin,DCDA)임신일태염색체비정배체진행록화갑선택성감태술적책략화임신결국. 방법 2008년6월1일지2012년12월30일재중산대학부속제일의원부산과태인의학중심취진적DCDA잉부20례,산전진단일태염색체비정배체,령일태핵형정상,우임신14～34주대이상태인실시심장주사록화갑감태술.분석술후유산、태막조파、조산등병발증급신생인결국. 결과 잉부평균년령위(33.8±4.3)세,평균감태잉주위(23.4±5.8)주,≤임신20주감태6례、21～27주감태8례、≥28주감태6례.1 7례피감태유기형등명현감태표기,3례부유초성연지표혹태인위치차별등약감태표기.20례균감태성공,20％(4/20)술후유산,35％(7/20)조산,45％(9/20)족월분면,총체신생인존활솔위65％ (13/20),무일례발생궁내감염.근궁경태인화원리궁경태인감태후미족월태막조파발생솔분별위7/12화0/8. 결론 대임신중만기DCDA일태염색체비정배체진행록화갑선택성감태술,모체안전,감태성공솔고.감멸근궁경적태인시,미족월태막조파발생솔고.
Objective To investigate the strategy and pregnancy outcomes of dichorionic diamniotic twins discordant for chromosomal aneuploidy undergoing selective termination with potassium chloride during the second and third trimester.Methods Twenty dichorionic diamniotic twins,discordant for chromosomal aneuploidy,who underwent selective termination in First Affiliated Hospital of Sun Yat-Sen University between June I,2008 and December 30,2012 were retrospectively analyzed.Chromosomal discordance was confirmed by karyotype analysis and (or) chromosome detection.Abnormal fetuses were terminated by the injection of potassium chloride into the fetal heart.The incidence of miscarriage,premature rupture of membranes,preterm labor and other complications after feticide were analyzed.Results The mean maternal age was (33.8 ± 4.3) years,and gestational age at feticide was (23.4 ±5.8) weeks.Six cases underwent feticide ≤ 20 weeks,eight at 21-27 weeks and six at ≥ 28 weeks.Severe sonographic markers leading to feticide included fetal anomaly in 17 cases,and weak sonographic markers,such as abnormal soft index or fetal position difference,were seen in three cases.Following successful feticide in all 20 cases,4/20 (20％) cases experienced miscarriage,7/20 (35％) ended pretermly,9/20 (45％) delivered at full term,and 13/20 (65％) had healthy babies.No intrauterine infection was observed.The incidence of preterm premature rupture of membranes was 7/12 and 0/8 in the terminated presenting fetuses and non-presenting fetuses,respectively.Conclusions Selective termination in dichorionic diamniotic twins discordant for chromosome aneuploidy is a safe procedure for mothers with a high success rate.The rate of preterm premature rupture of membranes is high in the terminated presenting fetuses.