| 早孕期双胎反向动脉灌注序列征的产前超声诊断 |
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| 引用本文： | 戢秀勤,杨小红,赵胜,路小军,张晓燕,张涛,黄晓宇. 早孕期双胎反向动脉灌注序列征的产前超声诊断[J]. 中华医学超声杂志(电子版), 2022, 19(12): 1355-1360. DOI: 10.3877/cma.j.issn.1672-6448.2022.12.007 |
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| 作者姓名： | 戢秀勤 杨小红 赵胜 路小军 张晓燕 张涛 黄晓宇 |
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| 作者单位： | 1. 430070 武汉,湖北省妇幼保健院超声科2. 448000 荆门市第二人民医院超声科 |
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| 基金项目： | 湖北省卫健委面上项目(WJ2021M188) |
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| 摘 要： | 目的总结早孕期（孕8~13+6周）双胎反向动脉灌注序列征（TRAPS）的超声表现及自然病程。 方法回顾性分析2001年5月至2020年12月于湖北省妇幼保健院产前超声诊断并经引产后或产后病理证实的早孕期TRAPS 75例,总结其早孕期超声特点及妊娠结局。 结果75例TRAPS中70例为双胎妊娠,5例为三胎妊娠。早孕期TRAPS超声声像图特点为：4例孕8~10周误诊为单胎妊娠,孕12~13+6周随访检查时诊断为双胎之一无心畸形。5例孕9~10+3周外院超声提示双胎之一“停育”,随访观察双胎之一“停育”的胎儿体积增大,与泵血儿（与孕龄相符）相比小0+4~2+1周,增大的胎儿可见胎动或肢体活动。无心畸胎儿58例无心脏结构及心管搏动,胎儿结构少伴多种严重畸形,17例有心脏遗迹和心管搏动,胎儿结构发育相对较好。17例无心胎儿淋巴水囊肿,3例颈项透明层增厚,55例未见明显水肿。彩色多普勒超声显示39例无心畸胎通过单一脐动脉反向灌注朝向无心畸胎儿体内。14例无心畸胎后期（妊娠12+3~16周）复查出现血流自然阻断,表现为无心畸胎与胎盘间细线样结构。泵血儿67例解剖结构正常,5例合并心脏畸形,1例唇裂,2例水肿,17例心功能不全（1例后期好转）。结局及预后为：75例TRAPS中,正常分娩15例泵血儿,其中12例泵血儿存活,3例新生儿死亡;19例因孕12+5~19周宫内双死胎、16例因心功能不全、1例因孕17周胎膜早破、8例因合并泵血儿畸形最终均引产,另16例家属选择引产。 结论早孕期TRAPS有其特征性的超声表现,经腹部联合经阴道超声,同时结合彩色多普勒的特殊血流表现及动态观察有助于早期明确诊断。
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| 关 键 词： | 超声检查 产前诊断 孕早期 双胎反向动脉灌注序列征 |
| 收稿时间： | 2021-07-12 |
Prenatal ultrasound diagnosis of twin reversed arterial perfusion sequence in early pregnancy |
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| Xiuqin Ji,Xiaohong Yang,Sheng Zhao,Xiaojun Lu,Xiaoyan Zhang,Tao Zhang,Xiaoyu Huang. Prenatal ultrasound diagnosis of twin reversed arterial perfusion sequence in early pregnancy[J]. Chinese Journal of Medical Ultrasound, 2022, 19(12): 1355-1360. DOI: 10.3877/cma.j.issn.1672-6448.2022.12.007 |
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| Authors: | Xiuqin Ji Xiaohong Yang Sheng Zhao Xiaojun Lu Xiaoyan Zhang Tao Zhang Xiaoyu Huang |
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| Affiliation: | 1. Department of Ultrasound, Maternal and Child Health Hospital of Hubei, Wuhan 430030, China2. Department of Ultrasound, Jingmen NO.2 People's Hospital, Jingmen 448000, China |
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| Abstract: | ObjectiveTo summarize the ultrasound features and natural course of twin reversed arterial perfusion sequence (TRAPS) during 8-13+6 weeks of gestation in the first trimester. MethodsA retrospective analysis was performed on 75 cases of TRAPS diagnosed by prenatal ultrasound in early pregnancy and confirmed by post-induction or postpartum pathology at Hubei Maternity and Child Health Hospital from May 2001 to December 2020 to summarize the ultrasound characteristics in early pregnancy and pregancy outcome. ResultsSeventy of the 75 cases of TRAPS were twin pregnancies, and the other 5 cases were triple pregnancies. Among them, 5 cases misdiagnosed as singleton pregnancy were referred to our hospital at 9-10+3 weeks of gestation, and 4 cases were misdiagnosed as singleton pregnancy at 8-10 weeks of gestation. The characteristics of TRAPS in early pregnancy were as follows: Follow-up observation found that the size of the fetus that was diagnosed as "stopped" in the early stage of twins increased, and "single pregnancy" was diagnosed as TRAPS. The pump fetuses with matching weeks were 0+4 - 2+1 weeks older than those with enlarged fetuses. Fetal movement or limb activity could be seen in enlarged fetuses. Fifty-eight cases of acardiac fetus had no heart structure or heart tube beating, and fetal structure was less with a variety of severe malformations. Seventeen cases had cardiac relics and heart tube beats, and the fetal structure was relatively well developed. Seventeen cases of acardiac fetuses had lymphatic cysts, 3 had nuchal translucency (NT) thickening, and 55 had no obvious edema. Color Doppler ultrasound revealed that 39 acardiac fetuses were perfused through a single umbilical artery. The blood flow was naturally blocked in the late stage (12+3-16 weeks of gestation) in 14 cases of acardiac fetuses, which showed a thin line-like structure between acardiac fetus and the placenta. Sixty-seven cases of pump fetuses had normal anatomical structures, 5 were complicated with cardiac malformations, 1 had cleft lip, 2 had edema, 5 had polyhydramnios, 2 had oligohydramnios, and 17 had cardiac insufficiency (1 case improved later). Regarding outcomes and prognosis, 15 cases of pump fetuses had a normal delivery, of which 12 survived and 3 died neonatally; 19 cases of intrauterine twin stillbirths at 12+5-19 weeks of gestation, 16 cases of cardiac insufficiency, 1 case of premature rupture of membranes at 17 weeks of gestation, and 8 cases of pump twin with malformations underwent induced labor; and 16 family members chose to undergo induced labor. ConclusionTRAPS in early pregnancy have characteristic ultrasound manifestations. The combination of abdominal and transvaginal ultrasound, color Doppler ultrasound, and dynamic observation are helpful for early diagnosis. |
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| Keywords: | Ultrasonography Prenatal diagnosis Early pregnancy Twin reversed arterial perfusion sequence |
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