Chai Han-jing, Luo Yan-min, Huang Xuan, Zhou Yi, Fang Qun
Fetal Medicine Centre, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China.
Zhonghua Fu Chan Ke Za Zhi. 2013 Jun;48(6):416-20.
To evaluate the perinatal outcome of three types of monochorionic diamniotic (MCDA) twins with selective intrauterine growth restriction (sIUGR).
From January 2005 to June 2012, clinical data of 42 pairs of MCDA twins (84 fetuses) with sIUGR and 71 pairs of normal MCDA twins (142 fetuses) in the same period were analyzed retrospectively in the First Affiliated Hospital of Sun Yat-Sen University. Fetuses with sIUGR were classified into three groups based on umbilical artery Doppler flow.There were 25 cases of type I, 11 cases of type II and 6 cases of type III. The perinatal outcome was compared between sIUGR and normal MCDA twins, and among the three types of sIUGR as well. Perinatal outcomes included gestational age at delivery, rate of intrauterine fetal death (IUFD), birth weight, intertwin discordance of birth weight, neonatal death and survival rate at 6 months.
(1) The gestational age of sIUGR at delivery was significantly earlier than the control group [(34±3), (36±2) weeks, respectively], and the rate of IUFD of both fetuses of sIUGR was significantly higher (4.8%, 0, respectively). In the sIUGR group, the average birth weight of large or small twins [(2130±350), (1520±400) g, respectively] was smaller than those in the control group [(2470±500), (2340±460) g, respectively]. The difference was statistically significant (P<0.05, P<0.01, respectively). The intertwin discordance of birth weight in sIUGR group was significantly larger (27.6%) than the control group (4.0%, P<0.01). (2) The gestational age at delivery in type II and type III [(34±5), (34±2) weeks, respectively] was significantly earlier than the control group (P<0.05). The rate of IUFD of both fetuses in type II (18%) was significantly higher than in type I (0) and the control group (0, P<0.05). In sIUGR group, the average birth weight of small twins in type I, type II and type III was (1640±430), (1330±310) and (1500±380) g respectively, all of which were significantly smaller than that in the control group (P<0.05). The average birth weight of small twins in type II was smaller than in type I and the difference was statistically significant (P<0.05). In sIUGR group, the intertwin discordance of birth weight in type I, type II and type III was 24.1%, 34.6%, 31.3% respectively, all of which were significantly larger than that in the control group (4.0%, P<0.05). There were no statistically significant differences of the intertwin discordance of birth weight among the three types of sIUGR (P>0.05). Survival rate at 6 months in type II (64%) was significantly lower than in type I (92%) and the control group (91.5%, P<0.01).
The perinatal outcome of MCDA twins with sIUGR is poor. The outcome is different among the three types of sIUGR, and typeIIis the worst. Type II is associated with a high risk of intrauterine fetal demise. It is important to monitor the intrauterine situation closely.
评估三种类型的单绒毛膜双羊膜囊（MCDA）双胎妊娠合并选择性胎儿生长受限（sIUGR）的围产期结局。
回顾性分析2005年1月至2012年6月中山大学附属第一医院同期收治的42对MCDA双胎妊娠合并sIUGR（84例胎儿）及71对正常MCDA双胎妊娠（142例胎儿）的临床资料。将合并sIUGR的胎儿根据脐动脉多普勒血流分为三组。I型25例，II型11例，III型6例。比较sIUGR双胎与正常MCDA双胎的围产期结局，以及三种类型sIUGR之间的围产期结局。围产期结局包括分娩孕周、胎儿宫内死亡（IUFD）率、出生体重、双胎出生体重差异、新生儿死亡及6个月生存率。
（1）sIUGR双胎的分娩孕周显著早于对照组[分别为（34±3）周、（36±2）周]，sIUGR双胎的IUFD率显著高于对照组（分别为4.8%、0）。在sIUGR组中，大或小双胎的平均出生体重[分别为（2130±350）g、（1520±400）g]低于对照组[分别为（2470±500）g、（2340±460）g]。差异有统计学意义（分别为P<0.05、P<0.01）。sIUGR组双胎出生体重差异显著大于对照组（27.6%比4.0%，P<0.01）。（2）II型和III型的分娩孕周[分别为（34±5）周、（34±2）周]显著早于对照组（P<0.05）。II型双胎的IUFD率（18%）显著高于I型（0）及对照组（0，P<0.05）。在sIUGR组中，I型、II型和III型小双胎的平均出生体重分别为（1640±430）g、（1330±310）g和（1500±380）g，均显著低于对照组（P<0.05）。II型小双胎的平均出生体重低于I型，差异有统计学意义（P<0.05）。在sIUGR组中，I型、II型和III型双胎出生体重差异分别为24.1%、34.6%、31.3%，均显著大于对照组（4.0%，P<0.05）。三种类型sIUGR之间双胎出生体重差异无统计学意义（P>0.05）。II型6个月生存率（64%）显著低于I型（92%）及对照组（91.5%，P<0.01）。
MCDA双胎妊娠合并sIUGR的围产期结局较差。三种类型的sIUGR结局不同，II型最差。II型与胎儿宫内死亡风险高相关。密切监测宫内情况很重要。
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