目的 探讨单绒毛膜双羊膜囊双胎妊娠(MCDA)选择性宫内生长受限(sIUGR)一胎胎死宫内(sIUFD)可能发生的原因、孕期主要监测指标及围产儿预后.方法 对2010年3月至2012年2月深圳市人民医院收治的双胎sIUGR且出现sIUFD的7例病例进行回顾性分析.统计sIUGR诊断时间,脐动脉、静脉导管等血流频谱及发现sIUFD的孕周,分娩后检查胎盘及脐带,随访围产儿预后.结果 7例病例诊断为sIUGR的平均孕周为23+4,出现脐动脉持续性舒张末期血流消失或反向(AREDF)至sIUFD间隔时间平均4+4周.脐动脉AREDF 5例,静脉导管血流异常2例(与发现sIUFD间隔时间为3d及5d).胎盘份额比值介于1∶1～10∶1,脐带过细、扭转、异常插入在死亡胎儿中分别为4例、2例、2例,存活儿中相应为2例、0例、1例.存活儿出生后出现神经系统损害1例.结论 胎盘份额分配不均衡及脐带异常是双胎sIUGR发生sIUFD的原因之一,静脉导管血流异常是预测新生儿死亡较可靠的指标,存活儿出生后大多预后良好.%Objective To investigate the possible causes, the antepartum parameters and perinatal outcomes of selective intrauterine growth restriction (sIUGR) and single intrauterine fetal demise (sIUFD) in momochorionic di amniotic (MCDA) twins. Methods Seven cases of sIUGR with sIUFD in MCDA twins were collected from March 2010 to February 2012 in Shenzhen People's Hospital. The clinical features were analyzed. Results The average time between the appearances of persistent absent or reversed end-diastolic flow (AREDF) to sIUFD was 4+4 weeks. The ratio of placenta distribution (the surviving one/died one) was between 1:1 and 10:1. The case number of small umbilical cord, umbilical cord torsion, and abnormal cord insertion in dead fetuses were 4, 2, and 2, but in the survival ones were 2, 0, and 1. One of the seven survivors had cerebral injury. Conclusion The unequal placenta share and umbilical cord abnormalities are the reasons for sIUFD. The prognosis of survivors is well.
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