妊娠早期不同一性发育双胎的妊娠结局

目的:评估双胎妊娠早期两胎儿不同一性发育的妊娠结局.方法:回顾性研究在216对双胎妊娠中共有19例(不同一组),41例为对照组.用方差分析和Fisher's exact test比较两组胎儿生长受限(IUGR)发生率、新生儿不同一性发生率和早产发生率情况.结果:不同一组IUGR发生率、新生儿不同一性发育发生率以及早产发生率分别为57.2%,35.7%,78.6%,显著高于对照组24.4%,7.5%和30%(P值分别为0.03,0.02和0.01),不同一组先天畸形的发病率高于对照组,当双胎不同一性比率(A-B/A)＞25%时,有显著性差异(P=0.039).所有发现的畸形均为易于识别的严重畸形.结论:双胎不同一性发育可发生于妊娠早期.双胎不同一性程度＞25%时,胎儿畸形率增高且为易识别的显著畸形.早期不同一性发育双胎的IUGR发生率、新生儿不同一性发生率和早产发生率均增高.

Perinatal outcome of first trimester growth discordance in twins

Objective: To evaluate perinatal outcomes of first trimester discordant twins(FTDT) to guild proper clinic consulting and optimize the treatment.Methods: This was a retrospective study on 19 first trimester discordant twin pregnancies among 216 women with twins pregnancy.First trimester discordance was defined as a CRL difference between two fetuses larger than 1 standard deviation for their gestational age.We enrolled 41 women randomly from the population as control group.Perinatal outcomes including the rate of malformation,IUGR late fetal growth discrepancy and preterm delivery were compared between discordant and concordant group.Results: The rate of IUGR,late fetal growth discrepancy and preterm delivery were significantly higher in first trimester discordant group(57.2%,35.7% and 78.6%) than concordant group(24.4%,7.5% and 30.0%;P=0.03,P=0.02 and P=0.01 respectively).Discordant group had a higher malformation rate than control group but not reach statistic significance unless the inter-twin discrepancy >25%(P=0.039).All the malformations were easy to be recognized.Conclusion: Twin discordance could appear as early as first trimester.Malformation rate in this study in discordant group is not significantly higher than in concordant group unless the inter-twin discrepancy >25%.FTDT has significant increased rate of IUGR and late pregnancy growth discrepancy and preterm dilivery.