产前超声监测对单绒毛膜双羊膜囊双胎妊娠一胎选择性生长受限的诊断及治疗选择的价值周琪侯莉张冬梅四川省成都市妇女儿童屮心医院四川成都610031作者简介：周琪(1976—)，女,四川人，本科，主治医师,主要从事妇产科超声工作.【摘要】目的近年由于辅助生育技术的不断发展成熟，促排卵药物的临床应用，国家计划生育政策的变动高龄产妇的增加，多胎妊娠逐年增多，双胎屮以单绒毛膜双胎并发症多见，双胎之一选择性胎儿生长受限(sFGR＞是其特殊的并发症之一，常引起胎儿宫内死亡及新生儿严重并发症和死亡.本文探讨单绒毛膜双羊膜囊双胎妊娠(MCDA),选择性胎儿生长受限的产前超声监测方法对诊断及治疗选择的价值.方法选取我院2013年5月至2015年5月从早孕开始在我院健卡，并诊断为单绒毛膜双羊膜囊的双胎的胎儿开始进行产前超声监测，并从屮诊断6例选择性生长受限的胎儿病例，进行相应的分期、分型和监测随访至妊娠终止.结果6例sFGR,20周前诊断1例,20周一29周诊断5例.其屮sFGRI型2例,34周一35周行剖宫产结束妊娠后大胎/小胎均存活.II型3例,2例屮小胎均出现静脉导管A波倒置或缺失，大脑屮动脉PI值降低，这2例胎儿孕周30周一33周行剖宫产结束妊娠后大胎/小胎均存活，另1例因孕周较小24周,超声检查时小胎已经死亡，相隔8小时后超声再次检查人胎也胎死宫内.III型1例34周行剖宫产结束妊娠后大胎/小胎均存活.结论早孕期诊断双胎妊娠的绒毛膜性具有重要的临床意义，早期诊断MCDA胎儿合并sFGR,并定期监测脐动脉、大脑屮动脉、静脉导管血流，其屮静脉导管异常是预测胎儿情况恶化的可靠指标.sFGR在超声严密的监测K选择分娩时机，可提高MCDA围生儿的生存率，且存活的胎儿出生后大多预后良好.【关键词】单绒毛膜双羊膜囊双胎；生长受限;超声；监测；诊断；治疗选择[Abstract]Objectivelnrecentyears,duetothecontinuousdevelopmentofassistedreproductivetechnology,theclinicalapplicationofovulationinductionmedicine,changesinthenationalonechildpolicyandtheincreaseofelderlyparturientwomen,themultiplepregnancyhasincreasedeveryyear,andthecompliGcationofmonochorionicdiamnioticisverycommonintwins,whiletheselectivefetalgrowthrestriction(sFGR)isoneofthespecialcomplications,whichoftencausesintrauterinefetaldeathandneonatalseverecomplicationsanddeath.Thepaperdiscussesthevalueofprenatalultrasoundmonitoringinthediagnosisandtreatmentoptionofmonochorionicdiamniotic(MCDA)twinswithselectiveintrauterinegrowthrestriction.MethodsSelectthetwins’fetusthatarediagnosedasmonochorionicdiamniotic,establishingthehealthcardfromearlypregnancyinourhospitalfromMay2013toMay2015,toperformprenatalultrasoundmonitoGring,andthenselectsixcasesdiagnosedasselectivityfetalgrowthrestrictiontoconductcorrespondingperiodization,classification,monitoringandfollow—uptotheterminationofpregnancy-ResultsOneofthesixcasesofsFGRwasdiagnosedbefore20weeks,andtheotherfivewerediagnosedform20to29weeks.Thereare2casesofsFGRTypelandboththebig/smallfetussurvivedaftertheendofpregnancybyperformingcaesareansectionsfrom34to35weeks.Thereare3caGsesofsFGRTypell,inwhich2caseswerefoundvenouscatheterAwaveinversionordeletionanddeclineofPIvalueinmiddlecerebralartery,boththebig/smallfetusofthesetwocasesweresurvivedaftertheendofpregnancybyperformingcaesareansectionsfrom30to33weeks;theothercaseissmallerof24gesGtationalweeks,thesmallfetalwasfounddiedwhenperformingtheultrasound,andthebigonewasfounddiedinuterowhenperformingtheultrasoundafter8hours.ThelastcaseisofsFGRTypelllandboththebig/smallfetussurvivedaftertheendofpregnancybyperformingcaesareansectionsin34weeks.ConcluGsionThediagnosisofchorionoftwinpregnancyinearlypregnancyisofimportantclinicalsignificance.ConductearlydiagnosisofMCDAtwinswithsFGRandre...