双胎反向动脉灌注序列征的MRI产前诊断（附4例报告及文献复习）

目的：探讨双胎反向动脉灌注序列征（TRAP）的 MRI表现及其诊断价值。方法：回顾性分析本院83例不同的胎儿畸形的 MRI资料,MRI扫描均采集单次激发快速自旋回波序列（SSFSE）、厚层重T2加权成像 SSFSE 序列、三维稳态进动快速成像（3D-FIESTA）序列,其中胎儿引产尸检及随访证实其中的TRAP有4例。分析其 MRI图像、临床资料及妊娠结局,总结TRAP的 MRI影像学特征。结果：4例TRAP 初次确诊的孕周为12～31周。4例TRAP 中每例无心胎儿均缺乏或无正常的心脏,且伴发各种不同的严重畸形。4例TRAP中1例于孕28周5天早产,双胎死亡;2例引产;1例无心胎儿于孕24周超声检查时发现无心胎儿死胎,继续妊娠至37周剖腹产分娩,泵血胎儿结局良好。结论：产前 MRI检查对于TRAP的早期诊断、预后判断、治疗方案及分娩时机的选择都有着重要的应用价值,MRI 是超声外对TRAP 的重要补充检查方法。     

RETRACTED ARTICLE: Perinatal and first year outcomes of spontaneous versus assisted twins: a single center experience

OBJECTIVE: The aim is to compare naturally conceived twins with twins conceived by assisted reproductive techniques (ART) by means of perinatal outcome, behavioural patterns and psychomotor development. MATERIAL AND METHODS: Three hundred and five spontaneous and 119 assisted twins were compared in aspects of behavioural patterns, mental and psychomotor development, as well as maternal and gestational age, foetal presentation, birth weight, sex, Apgar scores, perinatal complications, delivery route, and admission to neonatal intensive care unit (NICU) RESULTS: Although the maternal age was higher in assisted twins, the mean gestational age and birth weight of assisted twins were significantly less than those of spontaneous twins. The assisted twins did not differ from the naturally conceived twins in aspects of presentation, Apgar scores, admission to NICU and perinatal complications. However, caesarean section rate and the delivery rate of male foetuses were significantly higher in assisted twins. During the first year of life, retardation in mental and psychomotor development was more pronounced in assisted twins. Also assisted twins experienced behavioural problems and difficulties in parent-child interactions more frequently. CONCLUSIONS: Although twins born to assisted pregnancies had significantly shorter duration of gestation and thus less birth weight, their perinatal outcome was similar to that of spontaneous twins. The mothers of assisted twins may be keener on getting intensive prenatal care, which might in turn help to diminish any possible maternal and foetal risks. However, assisted twins showed significantly retarded psychomotor and mental development and experienced problems with environmental factors more frequently during their first year.     

Childhood cardiac function after twin-to-twin transfusion syndrome – a 10-year follow up

Aim:  To perform a 10-year follow up of cardiac structure and function after twin-to-twin transfusion syndrome (TTTS) – a severe foetal circulatory complication associated with myocardial hypertrophy in the recipient twin.
Methods:  Cardiac dimensions, systolic and diastolic function as assessed by echocardiography including flow and tissue Doppler velocimetry in 22 healthy survivors of TTTS with a mean age of 9.6 (7.2–11.8) years.
Results:  The donor and recipient twin did not show any differences in end-diastolic ventricular size, interventricular septum thickness, diameter of right ventricular outflow tract, cardiac valves, coronary arteries or in systolic blood flow velocities. However, compared with the donors, the recipients had significantly lower E/A ratios because of lower E-waves in both mitral (−0.15 ± 0.10, p < 0.01) and tricuspid (−0.09 ± 0.07, p < 0.01) valves, indicating reduced early diastolic ventricular fillings compared with donors.
Conclusion:  At school age, twins surviving TTTS had a cardiac structure and function within normal range. There were no differences in heart structure or systolic ventricular function between twins but, compared with the donor twin, we found a reduced early diastolic function in the recipient.     

IVF-ET受孕双胎与自然受孕双胎的妊娠结局比较

目的:了解体外受精-胚胎移植(IVF-ET)受孕双胎的产科并发症和围生儿发病风险。方法:回顾性分析南方医院1998年1月～2005年5月43例IVF-ET受孕双胎和75例自然受孕双胎的产科并发症和围生儿结局。结果:IVF-ET受孕双胎组的母亲年龄为(30.81±4.36)岁,自然受孕双胎组母亲年龄为(27.26±3.40)岁,两组之间有显著性差异(P<0.001);IVF-ET受孕双胎组孕34～37周间早产率显著高于自然受孕组(46.51%vs20.00%,P<0.01),OR值为3.478,OR值95%的可信区间为1.52～7.93;IVF-ET受孕双胎组剖宫产率显著高于自然受孕双胎组(88.23%vs67.86%,P<0.05),OR值为2.247,OR值95%的可信区间为1.017～4.965;IVF-ET受孕双胎组单卵双胎的发生率显著低于自然受孕组(4.60%vs22.66%);两组其他产前、产时并发症和围生儿并发症无统计学差异。结论:IVF-ET受孕双胎组母亲年龄较大,早产发生率较高,单卵双胎比例较低,分娩方式以剖宫产为主,其他产科并发症与围生儿并发症与自然受孕双胎组相似。     

Maternal cardiovascular adaptations to twin pregnancy

Multiple pregnancy places increased demands on the maternal circulation. Maternal left ventricular size and performance were measured with M-mode echocardiography in women with twin pregnancy in the second and third trimesters, and the findings were compared to those in normal singleton pregnancies. As expected, cardiac output was greater during twin than during singleton pregnancy; however, end-diastolic ventricular dimension was not. Output was increased in twin pregnancy during the second and third trimesters by heart rate and also during the third trimester by stroke volume. Increased stroke volume was effected by increased shortening, thus strongly suggesting increased contractility. Increased maternal heart rate and contractility during multiple gestations suggest that cardiovascular reserve is reduced.     

Simultaneous pregnancy in each cavity of a double uterus. A case report

A case of twin pregnancy in an anovulatory woman with uterus didelphys who conceived after ovulation induction is described. The management and possible complications of such cases are discussed.     

Ultrasound in multiple pregnancy

The advances in reproductive technologies have changed the demographics of multifetal pregnancies. Ultrasound has become the most essential tool to diagnose multifetal pregnancies and to contribute to the surveillance the mother and the fetus during pregnancy, delivery and the puerperium. In the first trimester, it enables us to diagnose the number of vital or non-vital multiples, chorionicity and amnionicity, the presence or absence of nuchal translucency, early growth discordance, severe malformations, and the origin of spontaneous and induced activities. In the second and third trimester, we can exclude malformations and disturbed growth. In addition, the opportunity to examine the cervix by transvaginal ultrasound should not be missed to detect the risk of spontaneous preterm birth. Ultrasound is essential for grading and treatment of twin-to-twin transfusion syndrome (TTTS), the diagnosis of malformations and growth disturbances. Evidence-based medicine has shown that the outcome of twin pregnancies can be improved by early diagnosis and Doppler velocimetry. Before and during labor, ultrasound is necessary for diagnosing the position of multiples, and in order to decide for the optimal route of delivery and in all phases of delayed interval delivery. Postpartum, it can be helpful for the differential diagnosis of severe hemorrhage.     

双胎妊娠合并贫血与妊娠结局的分析

目的：探讨双胎妊娠合并贫血对妊娠结局的影响，方法：将496例双胎妊娠分为两组，妊娠合并贫血者（贫血组）共321例，其余175例为对照组，对两组病的妊高征，产前出血，产后出血，早产，胎膜早破发生率与平均孕周，平均出生体重分别进行对照分析。结果：贫血组妊高征，产后出血，早产，胎膜早破发生率显著高于对照组（P＜0．05），且贫血严重程度与妊高征，产后出血发生率呈正相关（P＜0．05），与平均孕周呈负相关（P＜0．05）。两组新生儿平均出生体重无显著差异（P＞0．05），但重度贫血病例的新生儿平均出生体重与对照组比较，有显著性差异（P＜0．05）。结论：双胎妊娠合并贫血时各种并发症发生率成倍增加，特别是重度贫血对孕产妇和围生儿有严重的威胁。     

Establishment and application of criteria for the elective transfer of two good-quality embryos to reduce high-order multiple pregnancies

Aim  This study was carried out to establish criteria for the elective transfer of two good-quality embryos to reduce high-order multiple pregnancy rates. The pregnancy and multiple pregnancy rates per transfer were retrospectively analyzed in 128in vitro fertilization and embryo transfer (IVF-ET) cycles. Results  The analysis revealed that the pregnancy and multiple pregnancy rates were 26.6% (34 of 128) and 23.5% (eight of 34), respectively. Five twin and three triplet pregnancies were included. The pregnancy rates in women 29 years old and younger, 30–34 years, 35–39 years, and 40 years and older were 21.2 (seven of 33), 37.0 (17 of 46), 25.8 (eight of 31), and 11.1% (two of 18), respectively. There was a significant difference of the pregnancy rates between 30 and 34-year-old and 40-year-old and older women (P < 0.05). The multiple-pregnancy rate in women 40 years and older was 0%. Three triplet pregnancies were established only in the first attempt of IVF-ET. The pregnancy rates in women, to whom good-quality embryos (0–4) were transferred, were 0% (none of 12) for 0, 17.2% (five of 29) for one, 41.2% (seven of 17) for two, 30.8% (12 of 39) for three, and 32.3% (10 of 31) for four and more embryos, respectively. The multiple pregnancy rates in women who had good-quality embryos of one, two, three, and four and more transferred were 0% (none of five), 23.5% (four of seven), 16.7% (two of 12), and 20.0% (two of 10), respectively. Conclusion  The criteria for the elective transfer of two good-quality embryos were established as follows: age < 40 years, a first treatment cycle, and more than three good-quality embryos available for transfer. After the application of the established criteria, the overall pregnancy and multiple pregnancy rates were 30.4% (14 of 46) and 14.3% (two of 14), respectively, which was satisfactory as compared with those in the 128 IVF-ET cycles before application of the criteria. An elective transfer of two good-quality embryos can be highly recommended to avoid high-order multiple pregnancies in subjects with the established criteria.     

1O年多胎妊娠的变化

目的调查上海市6所医院10年多胎妊娠情况的变化.方法选择1993年1月～2002年12月的多胎妊娠病例,对其家族史、病史、妊娠并发症及妊娠结局进行统计学分析.结果10年中双胎的发生率为0.66%,3胎的发生率为19.01100 000,4胎的发生率为0.95100 000,前、后5年多胎妊娠发生率的差异无显著性(P＞0.05).与前5年相比,后5年的多胎妊娠中,使用辅助生殖技术的比率明显增加(P＜0.000 1).多胎妊娠的并发症以贫血最为多见,其次为妊娠高血压综合征、胎膜早破、妊娠肝内胆汁淤积症及产后出血,发生率分别为59.08%、21.94%、18.28%、9.00%和3.52%.多胎妊娠的早产发生率为65.26%,低体重儿发生率为48.20%,围产儿死亡率为27.46‰.前5年围产儿死亡15例,死亡率为23.92‰;后5年围产儿死亡24例,死亡率为30.26‰,两者间的差异无显著性(P=0.47).分娩方式中,剖宫产率为67.67%,其中后5年较前5年明显增加(P=0.046).结论上海10年的多胎妊娠发生率未受辅助生殖技术的影响,多胎妊娠的并发症多,早产、低体重儿发生率及围产儿死亡率较高,剖宫产的增加未能改善围产儿的死亡率.