Rodis J F, McIlveen P F, Egan J F, Borgida A F, Turner G W, Campbell W A
Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, USA.
Am J Obstet Gynecol. 1997 Nov;177(5):1046-9. doi: 10.1016/s0002-9378(97)70012-7.
Our goal was to report our 10-year experience with monoamniotic twins and to compare that experience with cases reported in the literature.
Records of all monoamniotic twin pregnancies managed at the University of Connecticut Health Center from March 1986 to August 1996 were reviewed. A MEDLINE search from January 1966 to August 1996 was performed, and each report was screened for accuracy of diagnosis. Only cases with umbilical cord entanglement of nonconjoined like-sex twins, the obstetrician's confirmation at delivery, or pathologic confirmation of monoamniotic placentation were included. Data collected were as follows: birth outcome, gestational age at delivery, birth weight, gender, Apgar scores, hematocrit, cord knotting, and neonatal complications. Cases from the literature were divided into those with prenatal diagnosis and those without.
Thirteen monoamniotic pregnancies resulting in 26 infants who were born alive were managed at our center. The average gestational age at diagnosis was 16.3 weeks. All had antenatal fetal surveillance including serial sonograms and nonstress tests. The average gestational age and birth weight at delivery were 32.9 weeks and 1669 gm, respectively. Cord entanglement was noted in all cases, with knotting in 8 of 13. Two pairs of 26 newborns had evidence of twin-twin transfusion syndrome. Eight of 13 monoamniotic pregnancies were delivered because of nonreassuring results of nonstress test, two because of preterm labor, two electively because of lung maturity, and one because of intrauterine growth restriction. Two of the 26 infants died in the neonatal period, one of congenital heart disease and one of sepsis and asphyxia. The MEDLINE search revealed 96 articles with a total of 202 sets of monoamniotic twins. Comparison of cases (13 sets) with the historic control group without prenatal diagnosis (77 sets) showed a 71% reduction in relative risk of perinatal mortality.
With accurate prenatal diagnosis, intensive fetal surveillance, and appropriately timed delivery, perinatal survival of monoamniotic twins is improved; it was 92% in this series.
我们旨在报告单羊膜囊双胎的10年经验，并将该经验与文献报道的病例进行比较。
回顾了1986年3月至1996年8月在康涅狄格大学健康中心管理的所有单羊膜囊双胎妊娠记录。进行了1966年1月至1996年8月的MEDLINE检索，并对每份报告的诊断准确性进行了筛查。仅纳入非联体同性双胎脐带缠绕、分娩时产科医生确认或单羊膜胎盘病理确认的病例。收集的数据如下：出生结局、分娩时孕周、出生体重、性别、阿氏评分、血细胞比容、脐带打结情况及新生儿并发症。文献中的病例分为产前诊断组和未产前诊断组。
我们中心管理了13例单羊膜囊妊娠，共26例活产婴儿。诊断时的平均孕周为16.3周。所有病例均进行了产前胎儿监测，包括系列超声检查和无应激试验。分娩时的平均孕周和出生体重分别为32.9周和1669克。所有病例均发现脐带缠绕，13例中有8例出现打结。26例新生儿中有2对存在双胎输血综合征证据。13例单羊膜囊妊娠中有8例因无应激试验结果不令人放心而分娩，2例因早产，2例因肺成熟而择期分娩，1例因胎儿宫内生长受限而分娩。26例婴儿中有2例在新生儿期死亡，1例死于先天性心脏病，1例死于败血症和窒息。MEDLINE检索显示96篇文章，共202例单羊膜囊双胎。将病例组（13例）与无产前诊断的历史对照组（77例）进行比较，围产期死亡率的相对风险降低了71%。
通过准确的产前诊断、强化胎儿监测和适时分娩，单羊膜囊双胎的围产期存活率得到提高；本系列中为92%。
