单绒毛膜双胎一胎无心畸形围产结局分析

目的 探讨单绒毛膜双胎并发一胎无心畸形的围产结局及围产期管理。方法 选择2010年5月至2014年5月在我院产科诊断、分娩的单绒毛膜双胎并发一胎无心畸形病例，回顾性分析在诊断无心畸形后期待治疗、选择性终止无心畸形胎儿妊娠方式的围产结局及管理。结果 共13例单绒毛膜双胎并发一胎无心畸形，单绒毛膜单羊膜囊（MCMA） 4例，单绒毛膜双羊膜囊（MCDA）7例，三胎妊娠合并无心畸形2例〔为单绒毛膜三羊膜囊（MCTA）、MCDA三胎妊娠〕。1例MCDA三胎妊娠孕21+3周因难免流产转入本院，产后尸检发现无心畸形，12例于孕11+5～31+6周产前诊断无心畸形。9例行期待治疗，其中2例MCMA双胎发生泵血胎死亡行引产，7例分娩孕周为31+3～39+5周，泵血胎生长发育良好。2例在孕24周、24+2周行脐带双极电凝术成功阻断无心胎脐带血流，于孕33+5周、32+1周剖宫产分娩，泵血胎生长发育良好。1例因未足月胎膜早破（PPROM）于孕28+6周转入本院后诊断出无心畸形，因宫内感染及时终止妊娠。结论 早期诊断、密切监护单绒毛膜双胎并发一胎无心畸形十分重要，必要时需要进行选择性终止无心胎妊娠以改善泵血胎妊娠结局，脐带双极电凝术为有效的宫内干预手段。

Perinatal Management for Monochorionic Twin Reversed Arterial Perfusion Sequence

Objective To evaluate the perinatal managementof monochorionic twin pregnancies complicated by twin reversed arterial perfusion(TRAP) sequence. Methods A retrospectively study was performed on the management and perinatal outcome of monochorionic multiple pregnanciescomplicated by TRAP sequence at West China Second University Hospital from May 2010 to May 2014. Results Thirteen cases of TRAP sequence were identified during the study period，included 4 monochorionicmonoamniotic (MCMA) twins, 7 monochorionic diamniotic(MCDA) twins,1 monochorionic-triamniotic (MCTA) triplet pregnancy and 1 MCDA triplet pregnancy. Gestational age at diagnosis of TRAP sequence was from 11+5 to 31+6 gestational weeks in 12 cases. TRAP sequence was diagnosed by post-mortem examination in the case of MCDA triplet pregnancy transferred to our hospital with inevitable abortion at 21+3 weeks.9 cases underwent conservative management.In the conservative management group,intrauterine death of the pump twin occurred in two MCMA twins and 7 cases delivered a healthy pump twin between 31+3 and 39+5 weeks of gestation. 2 cases were treated with bipolar cord coagulation of acardiac twin and delivered a healthy pump twin at 32+1 and 33+5 weeks of gestation. Conclusion Early antenatal diagnosis of TRAP sequence is very important. Consultation with the parents is recommended as to the options of conservative management or intervention. Conservative management with close monitoring may be a safe option for TRAP sequence with a small acardiac twin. Bipolar cord coagulation of acardiac twin is a relatively safe and effective procedure in TRAP sequence with indications to intervention.