双胎妊娠1530例胎儿丢失临床分析

目的 探讨双胎妊娠不同绒毛膜性胎儿在不同孕周发生围产儿丢失的风险及单绒毛膜双羊膜囊双胎(MCDA)胎儿丢失的原因.方法 回顾性分析2014年1月至2017年12月中国内地10所三级妇产科专科医院或妇幼保健院中分娩的1530例双胎妊娠,比较MCDA与双绒毛膜双羊膜囊双胎(DCDA)胎儿丢失的风险和发生孕周及原因.结果40...     

双胎妊娠产前诊断取样技术评估

产前诊断取样技术对双胎染色体异常的精准诊断必不可少。文章从双胎介入性产前诊断的标识系统、操作要点、术后相关风险及取样技术间的优劣对比等方面进行综述,为临床医生相关咨询及处理提供参考。     

双胎妊娠产前诊断取样技术评估

产前诊断取样技术对双胎染色体异常的精准诊断必不可少。文章从双胎介入性产前诊断的标识系统、操作要点、术后相关风险及取样技术间的优劣对比等方面进行综述,为临床医生相关咨询及处理提供参考。     

双胎妊娠的产前筛查和产前诊断

据统计，双胎妊娠约占总妊娠的1％～1．2％左右。双胎分为双卵双胎和单卵双胎，其中单卵双胎约占30％。双卵双胎为双绒毛膜双胎，其胎盘间没有血管吻合；单卵双胎分为双绒毛膜双羊膜、单绒毛膜双羊膜、单绒毛膜单羊膜、联体双胎，其胎盘间血管吻合发生率达85％以上，约15％的单绒毛膜双胎将发展为双胎输血综合征（twin-twin transfusion syndrome，TTTS）。由于双胎的自然流产率、早产率及围产儿死亡率都明显高于单胎，而绒毛膜特性又是影响双胎结局的最主要因素，单绒毛膜双胎的围产期死亡率是双绒毛膜双胎的3～5倍，所以双胎绒毛膜性质的诊断至关重要，也是讨论双胎产前诊断的前提。     

双胎妊娠生长不一致的诊治

双胎生长不一致是双胎妊娠特有并发症,发生原因有多方面,无论单绒毛膜还是双绒毛膜双胎的不一致,胎盘和脐带因素越来越受关注.期待处理不仅仅是监测发展及适时终止妊娠,针对改善胎盘功能的抗凝治疗等主动性干预在目前还需更多探索.     

超声在双胎妊娠中的应用

近年来 ,随着各种促排卵药和辅助性生育技术的广泛应用 ,双胎妊娠的发生率已有了明显的增加 ,据Martin等统计 ,1980～ 1997年间 ,美国双胎妊娠的发生率增长了5 2 % [1 ] ,且因双胎妊娠时其流产、早产及围产儿病死率亦均明显高于单胎妊娠 ,故对双胎妊娠的监护与保健日益受到人们的重视。B型超声及彩色多普勒超声检查以其操作简便、无创伤、可重复性好等优点 ,在双胎妊娠的孕期诊断及孕中晚期与分娩期监护等方面显示了良好的应用价值。现就其在双胎妊娠中的应用综述如下。一、双胎妊娠的特殊生理与病理双胎妊娠中 ,单绒毛膜双胎的胎盘间往往…     

双胎妊娠中一胎异常的筛查诊断与处理

双胎妊娠比单胎妊娠容易出现母胎并发症。单绒毛膜双羊膜囊双胎（MCDA）和双绒毛膜双羊膜囊双胎（DCDA）均可发生一胎异常。双胎之一异常在临床上主要表现为双胎生长发育不一致、染色体或基因异常和结构异常。为提高双胎妊娠的临床咨询与管理水平,文章就双胎妊娠中一胎异常的筛查、诊断与处理进行阐述。     

复杂性双胎妊娠超声诊断及孕期监测

复杂性双胎严重影响围产儿出生质量及预后,而利用超声对复杂性双胎进行诊断及评估既安全又可靠。如何在众多双胎妊娠中识别、诊断复杂性双胎,并对其进行有效孕期监护和及时处理,是改善复杂性双胎妊娠的预后及降低缺陷出生的关键所在。     

双胎妊娠孕期规范化诊疗和管理对围产儿预后影响研究北大核心CSCD

目的探讨双胎妊娠诊治规范和管理模式建立前后双胎妊娠绒毛膜性诊断的准确性和围产儿预后的改变。方法收集2010-01-01—2015-12-31在复旦大学附属妇产科医院杨浦院区产科分娩、经产后肉眼检查或胎盘胎膜病理检查明确绒毛膜性质的双胎妊娠孕妇444例,以本院2013-06-01起对双胎妊娠实施规范化诊疗和管理(简称"规范")为界分组,比较规范实施前后绒毛膜性诊断的准确性、妊娠结局及围产儿预后方面的差异。结果 (1)规范实施前后,收集病例的年龄、身高、体重之间差异无统计学意义(P>0.05)。(2)规范实施后,产前超声诊断绒毛膜性的比例较实施前明显增加(91.7%vs.70.2%,P<0.01),根据超声检查孕囊个数诊断绒毛膜性的比例明显增加(71.7%vs.60.0%,P<0.01);规范实施前有2例产后与产前绒毛膜性诊断不相符,规范实施后诊断均相符,但总体绒毛膜性的诊断准确率差异无统计学意义(P>0.05)。(3)规范实施后的择期剖宫产分娩孕周明显晚于规范实施前[(37.17±0.45)周vs.(36.93±0.51)周,P<0.01],其中双绒毛膜双胎择期剖宫产分娩孕周在规范实施后亦明显晚于规范实施前[(37.32±0.32)周vs.(37.03±0.46)周,P<0.01]。(4)规范实施前后的新生儿出生体重差异无统计学意义(P>0.05),母婴同室比例在规范实施后高于规范实施前(58.3%vs.54.1%,P<0.05),新生儿NICU入住率、出生后直接转院比例及放弃抢救比例低于规范实施前(37.4%vs.37.7%,4.3%vs.7.3%,0 vs.0.9%,P<0.05)。结论双胎妊娠诊治规范和管理模式的建立有利于围产儿预后的改善。     

多普勒超声在单绒毛膜性双胎并发症诊治中的应用价值

单绒毛膜性双胎并发症有较高的围产儿发病率和死亡率,产前的规范化监测及管理有助于改善围产儿结局。多普勒血流评估是监测单绒毛膜性双胎并发症的重要手段之一,包括脐动脉、大脑中动脉以及静脉导管血流的评估。文章针对上述多普勒血流的标准化测量及其在双胎并发症诊治中的应用价值进行了论述。     

双胎妊娠非整倍体异常的产前筛查与产前诊断

双胎妊娠非整倍体产前筛查较单胎复杂。应在早孕期确定孕周、绒毛膜性并测量颈项透明层厚度。早孕期联合筛查优于中孕期血清学筛查,但检出率明显低于单胎妊娠。无创产前检查用于双胎筛查仍需更多研究数据。双胎之一胚胎停育将影响早孕期筛查的准确性。产前诊断时区分标记双胎是需要注意的重要问题。     

双胎及多胎妊娠胎儿手术围手术期的超声监测

随着"二孩"政策的全面实施及辅助生殖技术的广泛开展，双胎及多胎妊娠发生率升高。对双胎及多胎妊娠实施减胎及对复杂双胎等接受手术处理的情况日益增多，双胎及多胎妊娠手术及围手术期管理亦日益规范化，对超声监测也提出了更高的要求。本文围绕双胎及多胎妊娠手术及围手术期超声监测的基础及进展进行讨论，以期为其临床管理提供超声诊断的保障与支撑。     

An omphalopagus parasitic twin after intracytoplasmic sperm injection

OBJECTIVE: To describe a first case of parasitic twin achieved after intracytoplasmic sperm injection (ICSI). DESIGN: Case report. SETTING: Perinatal center at a Japanese university hospital. PATIENT(S): A 30-year-old pregnant Japanese woman with a history of secondary infertility achieved after ICSI was diagnosed with an omphalopagus parasitic twin pregnancy by prenatal ultrasound at 28 weeks of gestation. INTERVENTION(S): A female infant was delivered by scheduled cesarean section at 30 weeks of gestation. The cesarean section was performed for dystocia. MAIN OUTCOME MEASURE(S): Brief review of parasitic twin and malformations in fetuses achieved after ICSI. RESULT(S): Resuscitation was not done because of the poor prognosis for both fetuses. Molecular analysis with informative genetic markers is consistent with monozygotic pregnancy. CONCLUSION(S): A careful ultrasound examination is indicated to detect additional anomalous findings in twin fetuses achieved after ICSI.     

Congenital cytomegalovirus infection among twin pairs

Objective: The purpose of this study was to describe the fetal/neonatal cytomegalovirus (CMV) status according to chorionicity and outcome in twin pregnancies diagnosed with CMV.

Methods: An opportunistic diagnosis of CMV infection was performed in a tertiary referral center. All cases diagnosed in twin pregnancies (2006–2011) were included. Prenatal diagnosis was performed by CMV-DNA in the amniotic fluid (AF) of both fetuses only on the evidence of sonographic findings in either one or both twins. Neonatal screening was selectively assessed in symptomatic newborns, preterm, and infants born to HIV-infected mothers. Congenital infection was considered in the presence of CMV-DNA in AF, fetal tissues or newborn urine within the first 2 weeks of life, and symptomatic disease with clinical findings at birth or autopsy.

Results: A total of six twin pregnancies with congenital CMV infection were diagnosed, five dichorionic and one monochorionic diamniotic. Only one sibling was infected among dichorionic pregnancies, two diagnosed prenatally, and three after birth. In the monochorionic pregnancy, the diagnosis was performed prenatally and the two fetuses were infected and severely damaged.

Conclusions: Congenital CMV infection in twins might be related, among other factors, to chorionicity, and in DC twins a non-concordant infection can be expected.     

Cervical varix accompanied by placenta previa in twin pregnancy

BACKGROUND: Uterine cervical varix is a rare complication in pregnant women and can be the cause of obstetric hemorrhage in the vagina resulting in adverse events for both the mother and fetus. CASE: A 34-year-old Japanese woman was hospitalized at 18 weeks gestation because of cervical varix and placenta previa. Prophylactic tocolysis successfully controlled the obstetric hemorrhage. At 27 weeks gestation, emergent cesarean section was performed because of intractable hemorrhage from the marginal placenta previa. Intraabdominal findings revealed no vascular malformation of the uterus, and the operation was performed uneventfully. A speculum examination of the vagina and cervix at 1 month postpartum were unremarkable. CONCLUSION: It is important to recognize the clinical features and available treatments for cervical varix.     

First-trimester molecular diagnosis of complete hydatidiform mole associated with dizygotic twin pregnancy conceived by intrauterine insemination

ObjectiveTo present first-trimester molecular diagnosis of complete hydatidiform mole (CHM) associated with dizygotic twin pregnancy conceived by intrauterine insemination.Materials and methodsA 32-year-old woman presented to the hospital with a huge complex cystic mass measuring about 8.5 cm × 4.1 cm in the uterine cavity and a living co-existing fetus with fetal biometry equivalent to 9 weeks. She underwent chorionic villus sampling at 13 weeks of gestation, and microsatellite genotyping for molar pregnancy test was applied. A molar pregnancy test was performed by a short tandem repeat (STR) identifier polymerase chain reaction (PCR) polymorphic marker analysis. The pregnancy was terminated at 14 weeks of gestation. Postnatal polymorphic DNA marker analysis of the placenta by quantitative fluorescent PCR (QF-PCR) was performed. Analysis of maternal blood total β-human chorionic gonadotropin revealed a high level of 551,600 mIU/mL at 10 weeks of gestation and a level of 1.0 mIU/mL at 15 weeks postpartum. The woman was doing well at 4 months after delivery.ResultsThe results of STR identifier PCR polymorphic marker analysis showed androgenic conception in the complex cystic mass and biparental conception in the living fetus. Pathological analysis of the cystic mass confirmed the diagnosis of CHM. The results of QF-PCR showed biparental inheritance in the normal fetus and complete paternal homozygosity in the CHM of the abnormal fetus in all STRs, indicating dizygotic twinning and CHM of monospermy.ConclusionPrenatal sonographic diagnosis of placentomegaly with many grape-like vesicles should include a differential diagnosis of CHM, partial hydatidiform mole (PHM), placental mesenchymal dysplasia (PMD), and recurrent hydatidiform mole. Microsatellite genotyping for molar pregnancy testing and zygosity testing is useful in cases of prenatal diagnosis of placentomegaly associated with many grape-like vesicles and a twin pregnancy with a living fetus in the first trimester.