Objective To discuss the perinatologyoutcome,clinical treatment and risk factors of monochorionic diamniotic twins pairs with selective fetal growth restriction(sFGR).Methods The clinical data of monochorionic twins with sFGR diagnosed in the Wuxi Civic Maternity and Child Health Hospital from Jan.2010 to Aug.2016 were retrospectively analyzed.Cases were categorized in to sFGR type Ⅰ,Ⅱand Ⅲaccording to the different doppler patterns of end diastolic flow velocity of the umbilical artery.Results 30 cases of monochorionic diamniotic twins with sFGR cases were found,all fetuses were with alive in 13 cases of type Ⅰ,there were 4 cases of in-trauterine demise of one fetus and 3 cases of neonatal death,and 1 case of termination of pregnancy in the middle of pregnancy,and 1 case of neonatal death due to quitting rescue,2 cases perinatal death in 10 cases of type Ⅱ,there were 2 cases of intrauterine demise of one fetus,and 1 case of neonatal death,and 1 case of termination of pregnancy in the middle of pregnancy,and 1 case of neonatal death due to quitting rescue,2 cases perinatal death in 7 cases of type Ⅲ.The weight of the larger fetus in cases of type Ⅰ was obviously higher compared with cases of type ⅡandⅢ(P<0.05).The weight of the smaller fetus in cases of type Ⅱ was significantly lower compared with cases of type ⅠandⅢ(P<0.05).The difference of birth weight in cases of type Ⅱ was obviously higher compared with cases of type Ⅰand Ⅲ(P<0.05).The perinatal mortality rate in cases of type Ⅱ was significantly higher than that of type ⅠandⅢ(P<0.05).The fetal mortality rate in cases with abnormal doppler spectrum of ductus venosus was obviously higher compared with cases with normal doppler spectrum of ductus venosus(P<0.05).The perinatal mortality rate in cases which was diagnosed sFGR before 26 weeks of gestation was significantly higher than that after 26 weeks of gestation(P<0.05).Conclusions The perinatal prog-nosis in cases of type Ⅰis better than that of type Ⅱand Ⅲ.There are several risk factors which led to the perinatal death in MCDA twins with sFGR,including the type ⅡandⅢ,the abnormal doppler spectrum of ductus venosus and the diagnosis of sFGR before 26 weeks of gestation.%目的 探讨单绒毛膜双羊膜囊双胎(简称单绒毛膜双胎)选择性胎儿生长受限(简称sFGR)的围生儿结局、临床处理及围生儿死亡的危险因素.方法 回顾性分析2010年1月-2016年8月在该院产科分娩的30例单绒毛膜双胎sFGR的临床资料,根据脐动脉舒张期血流频谱分为Ⅰ、Ⅱ、Ⅲ型.结果 30例单绒毛膜双胎sFGR中,Ⅰ型患者13例,围生儿均存活;Ⅱ型患者10例,发生一胎胎死宫内4例,3例存活胎围生期均死亡,1例孕中期引产,出生后放弃抢救死亡1例,2例围生儿均死亡;Ⅲ型患者7例,发生一胎胎死宫内2例,1例存活胎围生期死亡,1例孕中期引产,出生后放弃抢救死亡1例,2例围生儿均死亡.Ⅰ型大胎体质量明显大于Ⅱ、Ⅲ型,差异有统计学意义(P<0.05),Ⅱ型小胎体质量明显小于Ⅰ、Ⅲ型(P<0.05),Ⅱ型胎儿体质量差值明显大于Ⅰ、Ⅲ型(P<0.05).Ⅱ、Ⅲ型围生儿死亡率明显高于Ⅰ型(P<0.05),静脉导管血流频谱异常者围生儿死亡率明显高于静脉导管血流频谱正常者(P<0.05),发生sFGR<26周者围生儿死亡率明显高于发生sFGR≥26周者(P<0.05).结论 Ⅰ型围生儿预后最好,Ⅱ、Ⅲ型围生儿预后较差.Ⅱ型和Ⅲ型、静脉导管血流频谱异常及发生sFGR<26周是导致单绒毛膜双胎sFGR围生儿死亡的危险因素.
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