三胎妊娠早孕期减胎术后的围生结局分析

目的:探讨三胎妊娠早孕期选择性氯化钾减胎术后与未减胎单胎或双胎妊娠的围生结局差异。方法:收集广州医科大学附属第三医院2012年1月至2017年10月诊治的181例三胎妊娠孕妇早孕期行胎儿心内注射氯化钾减胎术(减至单胎组103例,减至双胎组78例)和未减胎单胎妊娠、双胎妊娠(未减胎单胎组58例,未减胎双胎组54例)的临床信息,并对比分析围生结局差异。结果:减至单胎组分别与减至双胎组和未减胎单胎组相比,其流产率(16.50%、3.85%、1.72%)和早产率(16.50%、55.13%、3.45%)、分娩孕周(37.37±0.26周、34.60±0.29周、39.05±0.20周)及新生儿出生体质量(2.71±0.06 kg、2.12±0.54 kg、3.07±0.07 kg)比较,差异均有统计学意义(P0.05)。减至双胎组与未减胎双胎组比较,其早产率(55.13%、35.19%)、分娩孕周(34.60±0.29周、36.04±0.27周)及新生儿出生体质量(2.12±0.54 kg、2.37±0.07 kg),差异有统计学意义(P0.05)。结论:尽管减胎术增加了孕妇早产率,但通过选择性减胎控制胎儿的数量来降低孕产期并发症仍是必要的。综合考虑流产率、早产率和胎儿发病风险,保留单胎可能更有利于胎儿围生结局和远期健康结局。     

体外受精-胚胎移植术后双胎之一手术减胎或自然减胎对妊娠结局的影响林

目的:探讨体外受精-胚胎移植(IVF-ET)治疗中，双胎妊娠实施早期选择性减胎术或胎儿发生自然减胎后对改善妊娠结局的影响。方法:回顾性分析2011年11月至2021年12月在厦门大学附属妇女儿童医院生殖医学科接受常规IVF-ET或卵胞浆内单精子显微注射-胚胎移植(ICSI-ET)的新鲜及冻融胚胎移植获单胎或双胎妊娠的患者共6535个周期(6535例)的临床资料，采用倾向性评分匹配(PSM)方法(1∶4)纳入研究对象，其中，手术减胎组与初始单胎组分别纳入128个周期和510个周期，自然减胎组与初始单胎组分别纳入511个周期和2038个周期。比较各组的妊娠结局指标。结果:PSM后手术减胎组及自然减胎组的移植胚胎数多于初始单胎组，分娩孕周早于初始单胎组，新生儿出生体质量低于初始单胎组，早产率、低出生体质量儿占比高于初始单胎组，差异均有统计学意义(P<0.05)。手术减胎组及自然减胎组的妊娠并发症(产后出血、妊娠期糖尿病、妊娠期高血压疾病)发生率、剖宫产率与初始单胎组比较，差异均无统计学意义(P>0.05)。流产率及新生儿出生缺陷率因PSM模型调整后数据缺失，按调整前计算，手术减胎组及自然减胎组的早期流产率均低于初始单胎组(P<0.05),自然减胎组晚期流产率低于初始单胎组(P<0.05);手术减胎组及自然减胎组的活产率高于初始单胎组(P<0.05);手术减胎组及自然减胎组的新生儿出生缺陷率与初始单胎组比较差异无统计学意义(P>0.05)。结论:辅助生殖技术(ART)助孕所致的多胎妊娠者，即使在孕早期实施减胎手术或发生自然减胎后对孕妇妊娠结局的影响有限，但早产率和低出生体质量儿出生率增加；减胎并不能完全逆转妊娠结局，限制移植胚胎数目才是解决ART助孕妊娠不良结局的根本办法。     

行IVF/ICSI各年龄段妇女早期单、双胎妊娠丢失的回顾性研究

目的:分析行IVF/ICSI的各年龄段妊娠妇女早期单、双胎妊娠胚胎丢失的影响因素。方法:回顾性分析行IVF/ICSI治疗,授精后第2日或第3日移植2~3个胚胎后单、双胎妊娠周期中早期妊娠囊丢失情况。结果:共收集到1 674个IVF/ICSI周期,孕6周单胚胎着床1 077例,双胚胎着床597例。孕12周时单胎和双胎的继续妊娠数分别为901例(83.66%)和548例(91.79%)(P<0.001)。双胎妊娠中,21例(3.52%)自然减胎成单胎,28例(4.69%)自然流产。单胎和双胎妊娠中,每个着床妊娠囊的丢失率分别为16.34%(176/1 077),6.45%(741/1 194)(P<0.001)。妊娠妇女早期妊娠囊丢失率单胎者高于同年龄段双胎妊娠者,26~37岁各年龄段妇女单胎与双胎妊娠丢失率间差异均有统计学意义(P<0.05),≥38岁妇女双胎妊娠丢失率显著增加。单胎妊娠组Gn每日用量显著高于双胎妊娠组(P<0.05),而受精率及优质胚胎率单胎妊娠组显著低于双胎妊娠组(P<0.001),Gn每日用量、受精率及优质胚胎率在妊娠丢失组和继续妊娠组间无统计学差异(P>0.05)。结论:双胎妊娠早期能获得更好的继续妊娠机会,随年龄增加尤其是≥38岁妇女,妊娠丢失显著上升。胚胎形态学质量好则有助于双胚胎着床,但是对继续妊娠没有直接明显的影响。     

体外受精-胚胎移植中多胎减胎后双胎妊娠结局的分析

目的:探讨IVF-ET中多胎妊娠减胎术对双胎妊娠结局的影响。方法:回顾性地分析IVF-ET治疗后直接双胎妊娠124例(A组)和IVF多胎妊娠减为双胎妊娠43例(B组),比较二组孕期流产率、早产率、胎儿出生体重、胎儿畸形率、新生儿死亡率、胎盘粘连和产后出血等。结果:早期流产率A组8.1%,B组25.6%;晚期流产率A组16.9%,B组9.3%;总流产率A组25%,B组34.9%;A、B组间流产率有显著差异(P<0.01)。A、B组平均孕周(36.6±2.2周vs36.0±2.9周)、第一胎胎儿出生体重(2678.0±510.3gvs2542.5±454.8g)和第二胎胎儿出生体重(2393.4±496.8gvs2297.5±501.0g)间无统计学差异;A、B组间在母体并发症发生率、胎儿畸形率、新生儿死亡率之间也无统计学差异(P>0.05)。结论:IVF-ET中多胎减为双胎妊娠与IVF-ET中直接双胎妊娠相比,早期流产率明显增加。     

辅助生殖技术助孕后的多胎妊娠早孕期减胎91例分析

目的:评价辅助生殖技术(ART)助孕后多胎妊娠早孕期减胎术的安全性及必要性。方法:回顾性分析91例多胎妊娠B超引导下经阴道选择性减胎患者的临床资料,统计其早期流产率、晚期流产率,并将减胎后的患者分为单胎妊娠组及双胎妊娠组,统计各组早产率、早产孕周、早产平均体质量及足月低体质量儿出生率,并与同期施行ART助孕的单胎妊娠及未行减胎的双胎妊娠4 623例进行比较分析。结果:减胎组早期流产率为2.20%,明显优于同期妊娠的早期流产率(10.96%),组间有统计学差异。减胎后的单胎妊娠组早产率、早期流产率及晚期流产率均优于未行减胎的双胎妊娠组。结论:早孕期施行B超引导下经阴道选择性减胎术是安全的,且可有效减少多胎妊娠发生,改善其不良妊娠结局。     

辅助生殖技术单卵双胎相关因素分析及含单绒毛膜双胎三胎妊娠减除单绒毛膜双胎之一的临床结局比较

目的探讨辅助生殖技术(ART)治疗后行多胎妊娠减胎术中单卵双胎(MZT)的发生和三胎妊娠行单绒毛膜双胎中一胎减胎术保留双胎者的临床结局。方法回顾性分析ART治疗后行经阴道多胎妊娠减胎术的196例患者的临床资料,分析比较MZT在不同分组中的发生情况,同时比较其中伴单绒毛膜双胎的三胎妊娠减单绒毛膜双胎之一者(A组)与不伴单绒毛膜双胎的三胎妊娠减胎后保留双胎者(B组)的临床结局。结果 (1)196例患者中MZT所占比率为44.39%(87/196)。MZT占比率在体外受精(IVF)组(0.85%)、卵胞质内单精子显微注射(ICSI)组(0.66%)、冻融胚胎移植(FET)组(0.78%)和人工授精(AIH/AID)组(0.16%)间比较差异有统计学意义(P=0.001);在辅助孵化(AH)组(1.48%)和无AH组(0.44%)间比较差异亦有统计学意义(P=0.000)。MZT占比率在高龄(≥35岁)和非高龄患者中(P=0.330)及卵裂期胚胎移植组和囊胚期胚胎移植组组间(P=0.950)比较差异无统计学意义。(2)A组和B组患者的平均年龄、平均孕周、新生儿的平均胎龄、平均胎儿出生体质量、流产率、早期流产率、晚期流产率、早产率、足月产率、活产率、低出生体质量儿发生率、新生儿出生缺陷率和妊娠并发症率比较,差异均无统计学意义(P0.05)。结论 ART行多胎妊娠减胎术的患者中MZT所占几率很高,为减少MZT的发生,尽量选择单胚胎移植;A组和B组患者临床结局无统计学差异,单绒毛膜双胎中一胎减胎术可能是安全而可行的。     

影响体外受精-胚胎移植和胞质内精子注射后早期妊娠结局因素的探讨

目的 :探讨影响体外受精 -胚胎移植 (IVF -ET)和胞质内精子注射 (ICSI)后早期妊娠结局的因素。方法 :测定IVF和ICSI胚胎移植 (ET) 2周后尿妊娠试验阳性 110例的当日血清绒毛膜促性腺激素 (hCG)值 ,于ET后 5周行B型超声检查 ,并对早期妊娠结局进行分析。结果 :早期妊娠 110例中 30例流产 ,除外 3例系减胎失败所致 ,流产率为2 5.2 % (2 7 10 7) ,其中IVF57例 ,流产 18例 ,除外 2例系减胎失败引起 ,流产率占 2 9.1%(16 55) ;ICSI53例 ,流产 12例 ,其中 1例因减胎流产 ,流产率占 2 1.2 % (11 52 ) ,两组流产率差异无显著性 (P >0 .0 5)。妊娠组与流产组的年龄和不孕时间差异有显著性 (P <0 .0 5) ,妊娠组血hCG值显著高于流产组者 (P <0 .0 1)。结论 :IVF—ET和ICSI后妊娠的早期流产率无明显区别 ,患者的不孕年龄和时间以及血hCG值与早期妊娠的结局有关     

妊娠中晚期双绒毛膜双胎一胎胎死宫内妊娠结局分析

目的：比较双绒毛膜双胎之一选择性减胎与自发一胎胎死宫内（single intrauterine fetal death,SIUFD）的围生期结局,并比较不同减胎孕周对围生期结局的影响,探讨选择性减胎的临床应用。方法：纳入2011年1月—2019年12月在南京大学医学院附属鼓楼医院产科终止妊娠的55例双胎之一胎死宫内或行选择性减胎术将双胎减至单胎的临床资料,根据减胎或死胎原因将其分为选择性减胎组（39例）和自发SIUFD组（16例）,回顾性分析比较其围生期结局。结果：55例患者总妊娠丢失率为9.1%（5例流产）,活产率为90.9%。选择性减胎组的减胎/死胎孕周明显低于自发SIUFD组,总体终止孕周、活产率明显高于自发SIUFD组,而剖宫产率、流产率则低于自发SIUFD组,差异均有统计学意义（P<0.05）。2组的早产率、足月产率、存活儿出生体质量、出生体质量百分位数、新生儿健康出院率、新生儿重症监护病房（neonatal intensive care unit,NICU）入住率比较,差异均无统计学意义（均P>0.05）。根据选择性减胎的孕周将选择性减胎组再分为减胎孕周≤20周组（24例）和减胎孕周>20周组（15例）,2组新生儿出生体质量百分位数比较差异无统计学意义（P>0.05）,但与减胎孕周>20周组比较,减胎孕周≤20周组的早产率低、足月产率高,存活儿出生体质量更高,差异有统计学意义（均P<0.05）。结论：双胎妊娠发生SIUFD后会对存活儿围生期结局产生不良影响,对于有减胎指征者,选择性减胎有利于提高存活儿围生期的活产率及改善新生儿结局,对多胎妊娠的围生期结局有益。     

经阴道途径与经腹部途径体外受精-胚胎移植多胎妊娠减胎术后妊娠结局的分析

目的比较体外受精-胚胎移植(IVF-ET)多胎妊娠在早孕早期(6~8孕周)经阴道减胎与早孕晚期(11~13+6孕周)经腹部减胎术后的妊娠结局,探讨多胎妊娠合适的减胎时机。方法 2014年1月—2016年12月期间于本院经超声波诊断的多胎妊娠拟行减胎手术患者,6~8孕周经阴道减胎组110例,11~13孕周经腹部减胎组78例,比较两组间早产率、流产率、低出生体质量率、胎儿体质量、孕周等。结果比较流产率、低出生体质量率、流产孕周、分娩孕周、平均胎儿体质量组间均无统计学差异。与经腹减胎组(5.13%,6.12%)比较,经阴道减胎组34~37孕周早产率明显升高(17.27%)、减胎个数分层显示6~8孕周双胎减一胎后早产率升高(19.40%)。结论与11~13+6孕周经腹部减胎比较,6~8孕周经阴道减胎组34~37孕周的早产率升高、双胎减一胎后的总体早产率升高。     

行辅助生殖技术助孕后子宫颈机能不全患者妊娠结局及其晚期流产的高危因素分析

目的:分析辅助生殖技术助孕后子宫颈机能不全(CI)患者妊娠结局及探讨其晚期流产的相关危险因素。方法:回顾性分析2010年5月至2018年12月在中山大学附属第六医院生殖中心行辅助生殖技术助孕妊娠后诊断CI患者(70例)的临床资料,将纳入孕妇分为多囊卵巢综合征(PCOS)组(17例)与非PCOS组(53例)和单胎妊娠组(44例)与双胎妊娠组(26例),比较患者的临床资料及妊娠结局。并采用Logistics回归分析CI患者晚期流产的高危因素。结果:①PCOS组患者平均终止妊娠孕周低于非PCOS组(22.85±7.26周vs 25.71±5.99周,P<0.05)。PCOS组妊娠期糖尿病的发生率明显高于非PCOS患者(41.18%vs 15.09%,P<0.05)。PCOS组患者晚期流产率明显高于于非PCOS组(76.47%vs 41.51%,P<0.05),而足月产率明显低于非PCOS组(5.88%vs 13.21%,P<0.05)。②双胎妊娠组患者平均终止妊娠孕周明显低于单胎妊娠患者(23.86±4.71周vs 25.86±8.02周,P<0.05),双胎妊娠组患者GDM的发生率高于单胎妊娠组(34.62%vs 13.64%,P<0.05),双胎妊娠组晚期流产的发生率高于单胎妊娠组(92.30%vs 31.82%,P<0.05),而足月产的发生率低于单胎妊娠组(3.85%vs 15.91%,P<0.05)。③Logistic回归分析提示仅双胎妊娠是CI患者晚期流产的独立危险因素(OR 1.862,95%CI 1.027~5.097)。结论:行辅助生殖技术助孕时,应尽量选择单胚胎移植。对于PCOS患者,孕前做好子宫颈评估,孕期监测子宫颈长度变化,加强产科管理,有助于改善妊娠结局。     

Retain singleton or twins? Multifetal pregnancy reduction strategies in triplet pregnancies with monochorionic twins

Objective

To assess the effectiveness and feasibility of retaining a singleton or twins for multifetal pregnancy reduction (MFPR) in triplet pregnancy with monochorionic twins.

Study design

This retrospective study was conducted from January 2006 to September 2011 at a university reproductive medical center. Multifetal pregnant patients (n = 35) with dichorionic triplets underwent MFPR in the first trimester to reduce one or both monochorionic twins. These cases were divided into two groups: Group A (9 MFPR cases to reduce one monochorionic twin) and Group B (26 MFPR for both monochorionic twins). Control A (for Group A) included another 18 cases of trichorionic triplet reduction to twins; Control B (for Group B) included 35 cases of trichorionic triplet reduction to singletons. MFPR was performed during the same period for all groups. Pregnancy outcomes were compared between groups.

Results

Patients were 28–39 years old; the average gestation for fetal reduction was 6–8 weeks. The early abortion rate was lower in Group A than Group B (0 versus 11.5%, p = 0.339), but the late abortion rate was significantly higher in Group A. (33.3% versus 0, p = 0.000). Groups A and B did not differ significantly in premature labor rate, term birth rate, gestation at delivery and take-home baby rate. The rate of very low and low birth weight was significantly higher in Group A than Group B (50% versus 0, p = 0.001), and the average birth weight was significantly lower in Group A (2391.7 ± 318.5 versus 3119.6 ± 523.9, p = 0.001). Group A had significantly more low birth-weight newborns than Control A (50% versus 13.3%, p < 0.05 [0.024]). Group B (retained singleton) had similar pregnancy outcomes and neonatal conditions as Control B.

Conclusions

Retaining a singleton is always the best choice when deciding about using MFPR to improve pregnancy outcomes. For patients having a triplet pregnancy with monochorionic twins and strongly desiring to keep twins, MFPR in one monochorionic twin was feasible by aspirating embryonic parts early in gestation (6–8 weeks) with no drug injection. Pregnancy outcomes are similar with twin reduction in trichorionic triplet pregnancy.     

Influence of spontaneous fetal reduction on dichorionic diamniotic twin pregnancy outcomes after in vitro fertilization: a large-sample retrospective study

Objective: To examine the incidence of spontaneous fetal reduction during dichorionic diamniotic (DCDA) twin pregnancy after in vitro fertilization and embryo transfer (IVF-ET) and its influence on pregnancy outcomes.

Methods: This was a retrospective cohort study of 4447 DCDA twin pregnancies and 14,551 singleton pregnancies after IVF-ET at a single center between 2009 and 2015. The spontaneous pregnancy reduction (SPR) group included 759 women. The remaining 3688 women with DCDA twins showing no spontaneous reduction were included in the non-SPR group. Outcomes were compared to a singleton group (n?=?14,551) treated over the same period. The overall rate of spontaneous reduction and frequency distribution across gestational epochs were determined and pregnancy outcomes were compared among the three groups. Further regression analysis was conducted to investigate whether spontaneous reduction was an independent risk factor for decreased take-home baby rate.

Results: The overall rate of spontaneous DCDA twin reduction after IVF-ET was 17.1%, with most cases (89.8%) occurring in the first trimester. Pregnancy outcome measures, including miscarriage rate, premature delivery rate, live birth rate, take-home baby rate, gestational age of delivery, and neonatal birth weight, were significantly better in the SPR group than the non-SPR group. Live birth rate, take-home baby rate, neonatal birth weight, and other primary outcome measures in the SPR group were not inferior to the singleton group. Multivariate regression analysis showed that the take-home baby rate was significantly lower in the non-SPR group (OR =0.73, 95%CI: 0.44–0.92, p?=?.008) and that SPR did not decrease the take-home baby rate.

Conclusions: Spontaneous pregnancy reduction is common in DCDA twin pregnancy after IVF-ET, but has little adverse influence on pregnancy outcomes and does not reduce the probability of taking home live babies.     

辅助生殖技术(ART)助孕获得多胎妊娠行减胎术后妊娠结局观察

目的:探讨辅助生殖技术(ART)获得的多胎妊娠孕早期行经阴道减胎术的有效性和安全性。方法:以经ART助孕获得多胎妊娠行经阴道减胎术的患者123例为减胎组,根据减胎后保留的胎儿数分为双胎组(A组,n=90)和单胎组(B组,n=33)。另以同期经ART助孕获得单胎妊娠(C组,n=36)和双胎妊娠(D组,n=57)的患者为对照组。回顾性分析患者的妊娠结局及妊娠期并发症发生情况。结果:减胎组的减胎成功率为100.0%,妊娠成功率为91.9%。A组胎膜早破发生率、早产发生率、新生儿低出生体质量发生率、新生儿重症监护室(NICU)入住率均高于B组(P<0.05)。结论:多胎妊娠孕早期行经阴道减胎术安全、有效、可行。多胎妊娠实施减胎术中减为单胎更为安全。     

Reduction of twin pregnancy to singleton: does it improve pregnancy outcome?

Objective.?To compare pregnancy complications, obstetrical and neonatal outcome of twin pregnancies reduced to singleton, with both non-reduced twin pregnancies and singleton pregnancies.

Methods.?A retrospective case–control study was performed at the Obstetrics and Gynecology Ultrasound unit of a tertiary referral medical center. Patient's population included 32 bi-chorionic bi-amniotic twin pregnancies reduced to singleton and 35 non-reduced twin pregnancies. Thirty-six patients with singleton pregnancies comprised the second control group. Main outcome measures were rates of pregnancy complications, preterm delivery (both before 37 weeks of gestation and before 34 weeks of gestation), late abortions, intra-uterine growth retardation, cesarean section, mean birth weights, and mean gestational age at delivery.

Results.?The reduced twin pregnancies group had similar rates of total pregnancy complications, preterm deliveries, and cesarean section as non-reduced twins. Gestational age at delivery and mean birth weight were also similar to non-reduced twins and significantly different compared with singletons. Preterm delivery and late abortion incidences were significantly higher when reduction was beyond 15 weeks gestation.

Conclusions.?Reduction of twin pregnancy to singleton does not change significantly pregnancy course and outcome. Favorable obstetrical and neonatal outcomes could be achieved by performing early, first trimester reductions.     

九例射频消融选择性减胎术的疗效及观察

目的: 探讨射频消融减胎术（radio frequency ablation,RFA）对复杂性多胎妊娠的疗效。方法: 回顾性分析2017年4月—2019年5月在武汉大学人民医院行RFA治疗的9例患者的临床资料,总结其临床疗效,包括流产、早产、足月产、活产、分娩方式和新生儿体质量等。结果: 9例患者中有2例是双绒毛膜三羊膜囊妊娠,有5例为单绒毛膜双羊膜囊双胎之一胎儿畸形行减胎术,1例为双胎输血综合征（twin-twin transfusion syndrome,TTTS）Ⅲ期减胎,1例为双胎之一选择性胎儿生长受限（selective fetal growth restriction,sFGR）Ⅱ型行选择性减胎术。9例患者均一次性RFA成功,手术成功率100%,均无手术并发症,仅1例于减胎术后2周流产,其余均获得活产。结论: RFA对复杂性多胎妊娠是一种安全有效且损伤小的宫内治疗方式,在临床上应该根据绒毛膜性及患者的意愿选择合适的减胎方式。     

15例双胎反向动脉灌注序列症的自然病程及围生儿预后探讨

目的:了解双胎反向动脉灌注序列症(TRAP序列症)的自然病程,分析其围生儿预后。方法:回顾性分析我院2008年7月至2011年12月收治的TRAP序列症15例患者的临床资料,对足月产、早产、流产及平均分娩孕周等资料进行统计,分析无心畸胎/供血儿的腹围比(AC比值)、脐动脉搏动指数(UA-PI)比、供血儿心脏情况等,并追踪供血儿出生后1年的健康状况。结果:15例TRAP序列症患者无心无头型11例,无心无脑型4例。10例孕早期超声检查误诊为双胎之一死亡(3例)、胎儿水肿(2例)和颈部淋巴水囊瘤(5例)。供血儿情况:羊水过多2例(1例引产,1例自然流产);心功能不全2例(1例因合并先天性心脏病引产,1例早产);羊水过多合并心功能不全1例(自然流产)。无心畸胎情况:无心畸胎血流自然阻断2例(13.3%),其中1例孕37周突发宫内死胎,1例继续妊娠(情况稳定);无心畸胎血流微弱(UA-PI比值<0.7)8例(53.3%),其中自然流产2例,引产1例,分娩活胎3例(追踪1年,3例新生儿均健康),继续妊娠2例(情况稳定);无心畸胎血流丰富5例(33.3%)(均引产)。另外无心畸胎出现迅速增长(AC比值>50%)共10例(66.7%),其中引产7例,自然流产1例,仅2例剖宫产分娩存活。结论:无心畸胎较小、血流不丰富者,自然病程良好。出现无心畸胎迅速生长、供血儿心力衰竭或水肿,提示胎儿死亡风险高或预后不良。     

双绒毛膜及单绒毛膜双胎与妊娠期并发症及围生儿结局分析

目的:探讨双胎妊娠绒毛膜性对孕妇妊娠期并发症及围生儿预后的影响及意义。方法:对我院定期随诊并分娩的472例双胎临床资料进行回顾性分析,根据绒毛膜性分为单绒毛膜双羊膜囊组(MCDA组)和双绒毛膜双羊膜囊组(DCDA组),对两组孕妇的分娩孕周、并发症以及围生儿预后等进行比较分析。结果:两组孕产妇妊娠并发症的发生率比较,差异无统计学意义(P>0.05)。MCDA组低出生体重儿、极低出生体重儿、新生儿窒息及围生儿死亡的发生率均明显高于DCDA组,其差异有统计学意义(P<0.05),MCDA组中双胎输血综合征发生率为7.32%。结论:绒毛膜性对孕妇妊娠并发症的发生无明显影响,而双胎孕妇于孕早期行B超检查诊断单绒毛膜或双绒毛膜对预测围生儿预后具有重要意义。尽早确定双胎类型,加强对单绒毛膜双胎的监护及干预,是改善胎儿和新生儿预后的关键。     

Impact of maternal pheochromocytoma on the fetus and neonate

Pheochromocytoma during pregnancy is rare but potentially harmful to the mother and fetus. Fetal risks are mainly determined by the vasoconstrictive effects of maternal catecholamine on uteroplacental circulation, because the fetus is protected from the direct effects of high catecholamine levels at the placental interface. Uteroplacental insufficiency may lead to spontaneous abortion, fetal growth restriction, premature delivery, and fetal hypoxia, followed by fetal distress and/or birth asphyxia. Adrenalectomy is recommended during the second trimester. When a diagnosis is made during the late second or third trimester, appropriate medical treatment until term and planned delivery with concurrent or delayed adrenalectomy can result in good fetal outcomes. Moreover, when adrenalectomy is planned after delivery, there is concern regarding the potential of antihypertensive drugs to be transferred to breast milk. It is generally known that early detection and proper treatment of pheochromocytoma during pregnancy decrease maternal and fetal mortality. However, in recent case series, antenatal maternal pheochromocytoma diagnosis did not significantly decrease the risk of fetal and neonatal mortality and morbidity, contrary to the maternal death and complication rates. Although intrauterine ischemia and hypoxia due to uteroplacental insufficiency can affect the long-term outcomes of neonates, no systematic studies have been performed.