Streit J A, Penick G D, Williamson R A, Weiner C P, Benda J A
Department of Pathology, University of Iowa.
Prenat Diagn. 1989 Jan;9(1):1-6. doi: 10.1002/pd.1970090102.
Persistence of elevated alphafetoprotein (AFP) levels and the presence of an acetylcholinesterase (AChE) band in amniotic fluid have been reported to occur up to 11 weeks following intrauterine fetal demise (IUFD) of one twin (Bass et al., 1986). We now report a case where such prolongation of these findings was observed in a case of unrecognized monochorionic, monoamniotic twinning, in which case cord entanglement resulted in IUFD at an estimated 10-12 weeks and 25-26 weeks. The fetus suffering early demise (Fetus B) had multiple congenital anomalies, including a neural tube defect. The presence of this defect and/or fetal demise and bleeding into the amniotic sac is entertained as continuing sources of documented elevated AChE and AFP 9-11 weeks after the initial fetal death. We re-emphasize the possibility of unrecognized twinning as a cause of abnormal maternal serum and amniotic fluid study results in the face of one apparently normal fetus.
据报道，单胎宫内胎儿死亡（IUFD）后长达11周，羊水甲胎蛋白（AFP）水平持续升高且出现乙酰胆碱酯酶（AChE）条带（Bass等人，1986年）。我们现在报告一例病例，在一例未被识别的单绒毛膜单羊膜囊双胎妊娠中观察到这些发现的延长情况，在该病例中，脐带缠绕导致估计在10 - 12周和25 - 26周时发生IUFD。较早死亡的胎儿（胎儿B）有多种先天性异常，包括神经管缺陷。这种缺陷的存在和/或胎儿死亡以及羊膜囊内出血被认为是最初胎儿死亡后9 - 11周记录到的AChE和AFP持续升高的持续来源。面对一个明显正常的胎儿，我们再次强调未被识别的双胎妊娠作为母体血清和羊水研究结果异常原因的可能性。
