Mahony B S, Petty C N, Nyberg D A, Luthy D A, Hickok D E, Hirsch J H
Division of Perinatal Medicine, Swedish Hospital Medical Center, Seattle, WA.
Am J Obstet Gynecol. 1990 Nov;163(5 Pt 1):1513-22. doi: 10.1016/0002-9378(90)90617-g.
Thirteen consecutive twin pregnancies affected by the "stuck twin" phenomenon were reviewed to determine the potential benefit of serial amniocenteses. The fetal survival rate for the eight pregnancies that underwent serial amniocenteses was 69% (11 of 16 fetuses). This is significantly improved compared with a fetal survival rate of 20% among the five preceding pregnancies managed without serial amniocenteses at the same institution (p = 0.01). It is also markedly improved compared with a combined fetal survival rate of 16% among 48 previously reported pregnancies with the stuck twin phenomenon managed without serial amniocenteses (p less than 0.0001). Survival correlated with the absence of concomitant pregnancy complications (i.e., maternal hypertension or intractable labor) and with the absence of severe fetal structural abnormalities. Procedural complications occurred in three of eight pregnancies (37.5%) managed with serial amniocenteses and was attributed as a cause of fetal death in one case. Two of 11 survivors (18%) had complications after serial amniocenteses including brain infarction and renal tubular necrosis. Serial amniocenteses may significantly improve the survival rate of twin gestations affected by the stuck twin phenomenon but may be associated with complications among survivors.
回顾了连续13例受“黏连双胎”现象影响的双胎妊娠，以确定连续羊膜腔穿刺术的潜在益处。接受连续羊膜腔穿刺术的8例妊娠中，胎儿存活率为69%（16个胎儿中的11个）。与同一机构之前未进行连续羊膜腔穿刺术处理的5例妊娠中20%的胎儿存活率相比，这有显著提高（p = 0.01）。与之前报道的48例未进行连续羊膜腔穿刺术处理的黏连双胎现象妊娠中16%的综合胎儿存活率相比，也有显著提高（p < 0.0001）。存活与无伴随妊娠并发症（即母体高血压或难产）以及无严重胎儿结构异常相关。在接受连续羊膜腔穿刺术处理的8例妊娠中有3例（37.5%）发生了操作并发症，其中1例将其归因于胎儿死亡。11例存活者中有2例（18%）在连续羊膜腔穿刺术后出现并发症，包括脑梗死和肾小管坏死。连续羊膜腔穿刺术可能显著提高受黏连双胎现象影响的双胎妊娠的存活率，但可能与存活者的并发症有关。
