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单绒毛膜性双胎脐带附着位置与双胎输血综合征、双胎生长不一致及胎儿结构畸形的相关性研究
作者：纪颖1  范丽丝2  贺晓3 
单位：1. 中国人民解放军第一五三中心医院 超声科, 河南 郑州 450000;
2. 中国人民解放军第一五三中心医院 妇产科, 河南 郑州 450000;
3. 郑州大学第一附属医院 超声科, 河南 郑州 450000
关键词：单绒毛膜性双胎 脐带附着位置 双胎输血综合症 生长不一致 胎儿结构畸形 
分类号：R714.2
出版年·卷·期（页码）：2017·36·第四期（633-636）
摘要：

目的：探讨单绒毛膜性双胎脐带附着位置与双胎输血综合征（TTTS）、双胎生长不一致及胎儿结构畸形的相关性。方法：自2010年10月至2016年10月行中晚孕超声检查单绒毛膜性胎儿共58例，每例胎儿均多切面扫查脐带附着位置，回顾性分析脐带附着位置异常双胎中TTTS、胎儿生长不一致及胎儿结构畸形的发生率。结果：58例单绒毛膜性双胎中双胎之一脐带为边缘性或帆状附着胎盘者共9例，均出现不同程度TTTS。双胎之一脐带附着位置近胎盘边缘13例，其中8例出现胎儿生长不一致，另5例胎儿生长发育参数无明显差异。胎儿严重结构异常4例，轻度结构异常10例，结构异常胎儿中仅1例胎儿脐带边缘附着。结论：单绒毛膜性双胎之一脐带附着位置为边缘性或帆状附着与TTTS有明确相关性；脐带附着近胎盘边缘与胎儿生长不一致的发生有一定关系，但不是决定性因素；脐带附着位置异常与胎儿畸形无明确相关性。

Objective:To investigate the relationship between umbilical cord attaching position and twin to twin transfusion syndrome (TTTS), growth discordance in twins and fetal structural abnormalities. Methods:58 cases of monochorionic twins in our hospital from 2010 to 2016 were studied. Each was performed late pregnancy ultrasound examination,and umbilical cord attaching position was scanned by multi-section. The incidence of TTTS, growth discordance in twins and fetal structural malformations in twin chorionic twins with umbilical cord attachment abnormalities were retrospectively analyzed. Results:Among 58 cases of monochorionic twins,one fetal umbilical cord was marginally positioned, 9 cases had velamentous insertion, and there were varying degrees of twin to twin transfusion syndrome. 13 cases had umbilical cord attachment near the placental edge, 8 cases had growth discordance in twins, the other 5 fetal growth parameters did no have significant difference. Fetal severe structural abnormalities were found in 4 cases, mild structural abnormalities in 10 cases, edge attachment of fetal umbilical cord was only found in one case. Conclusion:That one of monochorionic twins umbilical cord insertion position was marginal or velamentous had a clear correlation with the twin to twin transfusion syndrome. Umbilical cord attached to the placental edge has a certain relationship with growth discordance in twins, but it is not a decisive factor. There is no clear correlation between abnormal umbilical cord attachment position and fetal malformation.
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