摘要
目的评价单绒毛膜双羊膜囊(MCDA)双胎妊娠减胎术后的胎儿生长规律和围产结局。方法选取2016年1月至2020年12月在北京大学第三医院行选择性减胎术的MCDA双胎妊娠孕妇85例作为MCDA双胎减胎组,利用一般资料匹配同期171例单胎及165例MCDA未干预双胎孕妇作为对照组,回顾性分析三组间胎儿宫内发育及围产结局。结果单胎对照组的EFW、AC、FL、BPD及HC均大于MCDA双胎减胎组和双胎对照组,MCDA双胎减胎组的AC大于双胎对照组,其余指标与双胎对照组无明显差异。MCDA双胎减胎组的剖宫产比例(52.9%)显著低于双胎对照组(86.1%),与单胎对照组(39.2%)相比无统计学差异。MCDA双胎减胎组的分娩孕周为(37.1±2.7)周,早于单胎对照组(38.8±2.2)周而晚于双胎对照组(34.0±2.8)周,在32周和34周之前的早产比例(5.9%和11.8%)均低于双胎对照组(21.8%和46.7%),但与单胎对照组相比无统计学差异,在37周前的早产比例(30.6%)低于双胎对照组(78.8%)而高于单胎对照组(7.6%)。结论减胎术后保留胎儿的生长趋势同未减胎的MCDA双胎无明显差异,其围产结局主要与是否发生胎膜早破、早产有关。与未减胎的MCDA双胎孕妇相比,减胎术后存活新生儿的早产、低出生体重、小于胎龄儿和转NICU比例有一定程度降低,但与普通单胎相比仍较高。
Objective To evaluate the fetal growth pattern and perinatal outcome after selective feticide of monochorionic diamniotic(MCDA)twin pregnancy.Methods A case-control study was conducted during January 2016 to December 2020 in Peking University Third Hospital.85 MCDA twin pregnant women with selective feticide were selected as MCDA twin pregnancy with intervention group,171 singleton pregnant women and 165 MCDA twin pregnant women who did not undergo intervention(MCDA twin pregnancy without intervention group)were matched by general characteristics.The fetal intrauterine development and perinatal outcome of the three groups were analyzed.Results The estimated fetal weight(EFW),abdominal circumstance(AC),femur length(FL),biparietal diameter(BPD)and head circumference(HC)in the singleton control group were higher than those of MCDA groups,only AC in MCDA twin pregnancy with intervention is higher than those without intervention,and there was no significant difference in the other indicators between the twin groups.The cesarean section rate of MCDA twin pregnancy with intervention group was significantly lower(52.9%)than MCDA twin pregnancy without intervention group(86.1%),and there was no statistical difference compared with the singleton control group(39.2%).The gestational week of delivery of t MCDA twin pregnancy with intervention group(37.1±2.7)was earlier than that of the singleton control group(38.84±2.20)and later than that of MCDA twin pregnancy without intervention group(34.0±2.8).The preterm birth rate before 32 weeks and 34 weeks(5.9%and 11.8%)was lower than that of MCDA twin pregnancy without intervention group(21.8%and 46.7%),but there was no statistical difference compared with the singleton control group.The preterm birth rate before 37 weeks(30.6%)was lower than that of MCDA twin pregnancy without intervention group(78.8%)and higher than that of the singleton control group(7.6%).Conclusion There is no significant difference in the growth trend of the remaining fetus after selective feticide from those the MCDA twins without selective feticide,and its perinatal outcome is mainly related to whether there is premature rupture of membranes and premature delivery.Compared with MCDA twin pregnant women without selective feticide,the preterm birth,low birth weight,small for gestational age and NICU transfer rates of surviving newborns after selective feticide decreased to a certain extent,but they are still higher than those of normal singletons.
作者
原鹏波
周文君
吴天晨
尹韶华
杨静
魏瑗
赵扬玉
YUAN Pengbo;ZHOU Wenjun;WU Tianchen;YIN Shaohua;YANG Jing;WEI Yuan;ZHAO Yangyu(Department of Obstetrics and Gynecology,Peking University Third Hospital,Beijing 100191,China)
出处
《中国生育健康杂志》
2024年第2期115-121,共7页
Chinese Journal of Reproductive Health
基金
国家重点研发计划(2022YFC2704700)。
