Ishii Keisuke
Department of Maternal Fetal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan.
Curr Opin Obstet Gynecol. 2015 Apr;27(2):159-64. doi: 10.1097/GCO.0000000000000160.
The purpose of this article is to investigate the perinatal outcomes of monoamniotic twins under current standards of prenatal management involving intensive fetal surveillance.
The incidence of perinatal mortality in monoamniotic twins has fallen over the last 2 decades. Umbilical cord entanglement has long been considered one of the main causes of poor outcome among monoamniotic twins; however, new evidence shows that it appears to be less important than prematurity and congenital anomalies. If intensive fetal surveillance is provided, the risk of perinatal mortality is acceptably low regardless of setting. In uncomplicated monoamniotic twin pregnancies, delivery at around 33 weeks of gestation might reduce the risk of neonatal adverse events without increasing the risk of perinatal death.
Perinatal outcome in monoamniotic twins improved if intensive fetal surveillance was performed under either outpatient or inpatient management. Planned delivery in uncomplicated monoamniotic twin pregnancies can be considered at around 33 weeks of gestation.
本文旨在研究在当前包括强化胎儿监测的产前管理标准下，单绒毛膜单羊膜囊双胎的围产期结局。
在过去20年里，单绒毛膜单羊膜囊双胎的围产期死亡率有所下降。脐带缠绕长期以来一直被认为是单绒毛膜单羊膜囊双胎不良结局的主要原因之一；然而，新证据表明，它似乎没有早产和先天性异常那么重要。如果提供强化胎儿监测，无论在何种情况下，围产期死亡风险都低至可接受水平。在无并发症的单绒毛膜单羊膜囊双胎妊娠中，妊娠33周左右分娩可能会降低新生儿不良事件的风险，而不会增加围产期死亡风险。
无论是门诊还是住院管理，进行强化胎儿监测时，单绒毛膜单羊膜囊双胎的围产期结局都会改善。对于无并发症的单绒毛膜单羊膜囊双胎妊娠，可考虑在妊娠33周左右计划分娩。
