超声在多胎妊娠筛查和选择性减胎中的临床应用

目的评估超声在多胎妊娠筛查和选择性减胎中的临床应用价值。 方法选择2011年7月至2015年4月在南京大学医学院附属鼓楼医院妇产科产前诊断中心接受超声筛查及减胎术的46例多胎妊娠孕妇，分析其超声检出的多胎类型、绒毛膜性、胎儿异常及减胎手术指征，追踪减胎术后的妊娠过程和临床结局。 结果46例多胎妊娠孕妇中，双胎妊娠28例（60.87%，28/46），均是双绒毛膜双羊膜囊，5例妊娠无异常，孕妇要求减去其中一胎。21例因超声检出双胎之一发育异常减胎，2例因孕妇合并症减胎。三胎妊娠15例（32.61%，15/46），其中三绒毛膜三羊膜囊8例，胎儿均无异常，孕妇要求减去其中一胎；双绒毛膜三羊膜囊5例，3例胎儿无异常，均减去其中单绒毛膜双羊膜囊两胎，2例因单绒毛膜双羊膜囊两胎之一异常，分别减去单绒毛膜双羊膜囊中两胎及一胎；双绒毛膜双羊膜囊2例，其中1例单绒毛膜单羊膜囊两胎之一异常，均减去单绒毛膜单羊膜囊两胎。四胎妊娠3例（6.52%，3/46），胎儿发育均正常，均减去其中两胎，保留两胎。随访：双胎妊娠减胎术后保留28胎，1胎中孕超声检出左侧多囊性肾发育不良，2胎流产，其余25胎正常。三胎、四胎减胎术后保留胎儿均正常。 结论早期超声可以检出多胎妊娠的类型及异常胎儿，重视多胎妊娠的早期产前诊断并及时干预可以改善其妊娠结局。

Clinical application of ultrasound in screening of multiple pregnancy and selected termination

ObjectiveTo evaluate the clinical value of ultrasound in screening and selected termination of multiple pregnancy. Methods46 cases of multiple pregnancy who received ultrasound screening and selected termination in our prenatal diagnosis center from July 2011 to April 2015 were collected. The type of multiple pregnancy, chorionicity, fetal abnormalities and indications of selected termination were analyzed, and the pregnancy process and clinical results after the selected termination were followed up. ResultsOf all the cases,28 cases were twin pregnancy which were all dichorionic/diamniotic. 5 cases of the twin pregnancy underwent selected termination due to mothers` demand, in which all fetuses were normal. 21 cases of the twin pregnancy were terminated, because structural abnormalities were detected in one of the twins by ultrasound. The rest two cases of twin pregnancy were terminated because of pregnant complication.15 cases were triplet pregnancy. Of them, 8 cases of these were trichorionic/triamniotic and all fetuses were normal. But due to mothers` demand, selected termination was performed in each case. 5 cases of the triplet pregnancy were dichorionic/triamniotic. And the monochorionic/diamniotic twins were selected terminated in 3 cases. Also structural abnormalities were detected in one of the monochorionic/diamniotic twins in 2 cases. Of these two cases, monochorionic/diamniotic twins selected termination was performed in both twins in one case and in the abnormal twin in another case. Among 15 triplet pregnancy cases, 2 cases were dichorionic/diamniotic pregnancy with one abnormal fetus, and the two fetuses were all selected terminated. 4 cases were quadruplet pregnancy, all fetuses were normal but two fetuses were reduced in each case. According to the follow-up results, 28 fetuses were retained after selected termination, of which one fetus with left multicystic renal dysplasia was detected in the second trimester, two fetuses were abortion, and the remaining twenty five fetuses were normal. Fetuses were all normal after selected termination in triplet and quadruplet pregnancy. ConclusionsUltrasonic examination of early pregnancy can confirm the type of multiple pregnancy and detect the abnormal fetus. Prenatal diagnosis in early period and appropriate intervention can improve the pregnancy outcome of multiple pregnancy.