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单绒毛膜单羊膜囊双胎妊娠的临床特征与结局

[Clinical characteristics and outcomes of monochorionic monoamniotic twin pregnancy].

作者信息

Zhang C Y, Wei Y, Zhao Y Y

机构信息

Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China.

出版信息

Zhonghua Fu Chan Ke Za Zhi. 2020 Sep 25;55(9):627-632. doi: 10.3760/cma.j.cn112141-20200531-00462.

Abstract

To investigate the clinical characteristics and outcomes of monochorionic monoamniotic (MCMA) twin pregnancy. The clinical data of 60 MCMA twin pregnant women who were terminated in Peking University Third Hospital from January 2011 to December 2019 were collected, and the general clinical data, prenatal examination and pregnancy outcomes were analyzed retrospectively. The age of 60 MCMA twin pregnant women was (31.0±4.1) years old, among which 44 cases were primiparas (73%, 44/60) and 16 cases were multiparas (27%, 16/60). Fifty-eight cases were diagnosed as MCMA twin pregnancy prenatally and were confirmed after delivery. Median ultrasonic diagnosis of gestational age was 12 weeks (range: 8-30 weeks). In the 60 MCMA twin pregnancies, 6 cases were conjoined twins, 5 cases were complicated with twin reversed arterial perfusion sequence (TRAPS), and 10 cases were diagnosed as other fetal malformation by prenatal ultrasound examination. Among the 60 MCMA twin pregnant women, 19 cases had spontaneous abortion or induced abortion due to fetal malformation, fetal death or other reasons within 28 weeks of pregnancy, 41 cases entered the perinatal period, a total of 70 newborns survived. The main cause of perinatal fetal or neonatal death was fetal dysplasia. There is a high incidence of fetal abnormality and perinatal mortality in MCMA twin pregnancy. Accurate early diagnosis, enhanced management and monitoring during pregnancy, and individualized treatment are the keys to improve MCMA twin pregnancy outcomes.

摘要

探讨单绒毛膜单羊膜囊(MCMA)双胎妊娠的临床特征及结局。收集2011年1月至2019年12月在北京大学第三医院终止妊娠的60例MCMA双胎孕妇的临床资料,对其一般临床资料、产前检查及妊娠结局进行回顾性分析。60例MCMA双胎孕妇年龄为(31.0±4.1)岁,其中初产妇44例(73%,44/60),经产妇16例(27%,16/60)。58例产前诊断为MCMA双胎妊娠,产后确诊。超声诊断孕周中位数为12周(范围:8 - 30周)。60例MCMA双胎妊娠中,联体双胎6例,合并双胎反向动脉灌注序列(TRAPS)5例,产前超声检查诊断其他胎儿畸形10例。60例MCMA双胎孕妇中,19例因胎儿畸形、胎儿死亡或其他原因在妊娠28周内自然流产或人工流产,41例进入围生期,共70例新生儿存活。围生期胎儿或新生儿死亡的主要原因是胎儿发育异常。MCMA双胎妊娠胎儿异常及围生期死亡率高。准确的早期诊断、加强孕期管理和监测以及个体化治疗是改善MCMA双胎妊娠结局的关键。

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