Reisner D P, Mahony B S, Petty C N, Nyberg D A, Porter T F, Zingheim R W, Williams M A, Luthy D A
Division of Perinatal Medicine, Swedish Medical Center/Seattle, WA 98104.
Am J Obstet Gynecol. 1993 Oct;169(4):991-5. doi: 10.1016/0002-9378(93)90041-g.
Our purpose was to further evaluate the role of serial amniocentesis in pregnancies complicated by the "stuck twin" syndrome.
A cohort of 37 consecutive cases of stuck twin syndrome was followed up from 1986 through 1992. Evaluations included gestational age at diagnosis and at delivery, mean number of amniocenteses, volume of amniotic fluid withdrawn, placentation, perinatal complications, fetal survival, and neonatal follow-up.
Five pregnancies were terminated, five had no intervention, and 27 underwent serial amniocenteses. The mean number of amniocenteses was 3.4 (range 1 to 6), and mean total amniotic fluid volume withdrawn was 5.8 L (range 0.75 to 4.0). In the serial amniocentesis group mean gestational age was 23.1 weeks (range 16 to 30) at diagnosis and 31.5 weeks (range 20 to 38) at delivery. Eighty-two percent had monochorionic placentas, and 36% had marginal or velamentous cord insertions. Infant survival was 39 of 54 (74%) in the serial amniocentesis group compared with four of 10 (40%) in the nonintervention group (relative risk 0.46, 95% confidence interval 0.24 to 0.90).
Serial amniocentesis was associated with a 54% reduction in fetal and neonatal death in cases of stuck twin syndrome.
我们的目的是进一步评估连续羊膜腔穿刺术在并发“联体双胎”综合征妊娠中的作用。
对1986年至1992年期间连续37例联体双胎综合征病例进行队列研究。评估内容包括诊断时和分娩时的孕周、羊膜腔穿刺术的平均次数、抽出的羊水量、胎盘情况、围产期并发症、胎儿存活情况及新生儿随访。
5例妊娠终止，5例未干预，27例接受连续羊膜腔穿刺术。羊膜腔穿刺术的平均次数为3.4次（范围1至6次），抽出的羊水量平均总量为5.8升（范围0.75至4.0升）。在连续羊膜腔穿刺术组，诊断时平均孕周为23.1周（范围16至30周），分娩时为31.5周（范围20至38周）。82%为单绒毛膜胎盘，36%为边缘性或帆状脐带附着。连续羊膜腔穿刺术组54例中有39例（74%）婴儿存活，未干预组10例中有4例（40%）存活（相对危险度0.46，95%可信区间0.24至0.90）。
在联体双胎综合征病例中，连续羊膜腔穿刺术使胎儿和新生儿死亡减少了54%。
