双胎之一完全性葡萄胎产前超声特征与临床结局对照分析

目的探讨双胎之一完全性葡萄胎产前超声声像图特征及超声诊断的临床意义。 方法对北京大学第三医院2010年1月至2015年1月产前超声诊断或可疑为双胎之一完全性葡萄胎11例孕妇的临床、超声图像检查资料进行分析，并与胎儿临床结局及病理诊断结果对照。 结果11例孕妇中产前超声提示孕11~13周双胎之一完全性葡萄胎9例，可疑双胎之一完全性葡萄胎2例（1例分娩后证实为双胎之一胚胎停育后胎盘梗死灶，1例产后证实为部分性葡萄胎），其中6例为体外受精-胚胎移植后妊娠，均移植新鲜或冻胚胎2枚，1例为服用促排卵药物后妊娠。双胎之一完全性葡萄胎声像图均表现为宫腔内正常发育的胎儿、胎盘，另可见胎盘旁葡萄胎声像图。9例双胎之一完全性葡萄胎中8例早孕期超声检查（孕6~10周），其中5例均存在异常声像图，其声像图均表现为宫腔内正常胎囊、胎芽及胎心搏动，另可见胎囊旁不均质不规则团块状中等或低回声，类似宫内早孕合并宫腔积血或胚胎停育的声像图表现。全部病例均经病理和染色体分析证实。 结论孕11~13周双胎之一完全性葡萄胎具有典型的声像图特征，早孕期超声检查具有异常声像，需与宫内早孕合并宫腔积血或双胎之一胚胎停育鉴别；需根据β-hCG水平与增长情况、葡萄胎大小与增长情况、孕周及有无并发症决定继续妊娠或终止妊娠等临床处理方式。因此，超声在双胎之一完全性葡萄胎诊断及后续治疗中均有重要临床价值。

The comparative analysis of prenatal ultrasonographic features and clinical outcome of a twin pregnancy consisting of a complete mole and coexisting fetus

ObjectiveTo discuss the prenatal ultrasonographic features of a twin pregnancy consisting of a complete mole and coexisting fetus (CMCF), and the clinical significance of ultrasonography in diagnosis of CMCF. MethodsIn this study, the ultrasonographic features of eleven women who were diagnosed or suspected as CMCF from January 2010 to January 2015 were analyzed, and the imaging findings were compared with the clinical outcome and postnatal pathologic findings. ResultsNine of eleven women were diagnosed as CMCF by ultrasound at the 11^st-13^rd gestational week, and the other two women were suspected cases. After pregnancy termination, one of the suspected cases was confirmed as placental infarction secondary to single death in twins, while the other one was proved to be partial hydatidiform mole. Six of all eleven women got pregnant after in vitro fertilization-embryo transfer (IVF-ET). They were all transferred two fresh or frozen-thawed embryos, one woman underwent ovulation induction therapy before pregnancy. In all of the CMCF cases ultrasound examination demonstrated a normally growing live fetus with a normal placenta and an additional intrauterine echogenic mass with features of hydatidiform mole. Eight of nine CMCF cases underwent ultrasound examination at the 6^th-10^th gestational week, five of which were abnormal on ultrasonogram during this period. In these cases, the normal gestational sac and embryo with heartbeats could be observed alongside heterogeneous iso- or hypo echoic mass of irregular shape. However, the sonographic appearance was similar to early intrauterine pregnancy complicated with hemorrhage in the endometrial cavity or single death in twins. All cases were confirmed by pathologic or chromosome examination. ConclusionsUltrasonogram of CMCF is typical at the 11^st-13^rd gestational week, and ultrasonic diagnosis has important clinical application value. The abnormal ultrasonogram of CMCF in the early-period pregnancy should be differentiated from early intrauterine pregnancy complicated with hemorrhage in the endometrial cavity or single death in twins. Management, including the decision on whether to continue pregnancy and the timing of termination, depends on the level and its increase of β-hCG, the size of mass and its growth, the gestational week and existence of complications. Therefore, Ultrasonography has important clinical significance in diagnosis of CMCF.