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目的探讨产前超声诊断的复杂性单绒毛膜双胎的妊娠结局。方法选取2014年1月至2016年10月早孕期超声诊断的单绒毛膜双胎(monochorionic twin,MC)232例,从妊娠16周起定期超声监测各项生长指标、脐血流、大脑中动脉血流频谱及羊水、胎盘情况,并比较复杂性(42例)和非复杂性单绒毛膜双胎(190例)的妊娠结局。结果复杂性单绒毛膜双胎的丢失率(23.8%,10/42)、早产率(88.1%,37/42)显著高于非复杂性单绒毛膜双胎(4.7%,9/190;43.2%,82/190;P<0.05),其活产率(76.2%,32/42)则显著低于非复杂性MC(95.3%,181/190;P<0.05)。42例复杂性单绒毛膜双胎中,双胎输血综合征(TTTS)8例,羊水过多-过少序列(TOPS)表现8例(Ⅰ期1例,Ⅱ~Ⅴ期7例);选择性宫内生长受限(s FGR)32例(Ⅰ型25例,Ⅱ~Ⅲ型7例);双胎反向动脉灌注序列征(TRAP)2例;双胎贫血多血序列征(TAPS)4例,其中TAPS合并s FGR 2例,s FGR进展为TTTS 2例。Ⅰ期与Ⅱ~Ⅴ期TTTS,Ⅰ型与Ⅱ~Ⅲ型s FGR的活产率、丢失率比较,差异均无统计学意义(P>0.05)。结论复杂性单绒毛膜双胎属于高危妊娠,其活产率、早产率低于非复杂性单绒毛膜双胎;产前超声可以评估和监测复杂性单绒毛膜双胎妊娠的并发症。
Objective To investigate the pregnancy outcome of complex single chorionic twins diagnosed by prenatal ultrasound. Methods From January 2014 to October 2016, 232 cases of monochorionic twin (MC) diagnosed by ultrasound in early pregnancy were selected. The growth parameters, umbilical blood flow, middle cerebral artery Blood flow spectrum and amniotic fluid, placenta, and more complicated (42 cases) and non-complex single chorionic twins (190 cases) pregnancy outcome. Results The rate of loss of single chorionic twins was 23.8% (10/42) and the rate of premature delivery was 88.1% (37/42), significantly higher than that of uncomplicated chorionic twins (4.7%, 9/190; 43.2 %, 82/190; P <0.05). The live birth rate (76.2%, 32/42) was significantly lower than that of non-complex MC (95.3%, 181/190; P <0.05). Among the 42 cases of complicated single chorionic twins, 8 cases had twin twin transfusion syndrome (TTTS), 8 cases had oligohydramnios - TOPS (1 case in stage Ⅰ and 7 cases in stage Ⅱ ~ Ⅴ) There were 32 cases of intrauterine growth restriction (s FGR) (25 cases of type Ⅰ, 7 cases of type Ⅱ ~ Ⅲ), 2 cases of twin reverse arterial perfusion (TRAP) 4 cases, of which TAPS combined s FGR 2 cases, s FGR progress to TTTS 2 cases. There was no significant difference in the live birth rate and the loss rate of TTF between Ⅰ and Ⅱ ~ Ⅴ TTF, Ⅰ and Ⅱ ~ Ⅲ s FGR (P> 0.05). Conclusions The complexity of single chorionic twins is at high risk of pregnancy, and their live birth rate and premature birth rate are lower than those of uncomplicated single chorionic twins. Prenatal ultrasound can evaluate and monitor the complications of complex single chorionic twins.