| BackgroundMonochorionic twins are formed by the division of a single fertilized egg at the earliest stage of embryogenesis,and the twins share a placenta with the same set of-genes.Because monochorionic twins share the specificity of vascular anastomosis between the placenta,special complications such as twin-twin transfusion sy'ndrome(TTTS)and selective intrauterine growth restriction(sIUGR)and Twin reversed arterial perfusion sequence(TRAPS)are prone to occur.Monochorionic twins with these special complications,also known as complex twins pregnancy,which need special clinical monitoring.At present,the special complications are usually diagnosed by ultrasound after the corresponding ultrasound features appear in the middle and late gestations.In addition,different types of conjoined twins can be produced due to the different time of splitting.Complications of these monochorionic twins can lead to higher morbidity and mortality in perinatal neonates.Therefore,accurate assessment and discovery of complications as soon as possible can give appropriate clinical intervention and consultation,thereby reducing their morbidity and mortality,improving the prognosis of the fetus,and has great clinical value.PART ? Retrospective analysis of ultrasound characteristics and outcomes in middle/late pregnancy of monochorionic twins with complicationsObjection:Retrospective analysis of the relationship between the ultrasound features of the special complications of monochorionic twin pregnancy and clinical outcomes,to provide a basis for improving the early diagnosis rale of special complications of monochorionic twins,thus helping clinicians to make timely diagnosis and treatment measures and reasonable advisory.Method:During the period from January 2014 to March 2018,seventy-nine cases of monochorionic twin pregnant women who were referred to the Department of Ultrasound Examination of Shenzhen Maternal and Child Healthcare Hospital of Southern Medical University or suspected of twin complications in the external hospital.Retrospective analysis of prenatal ultrasound,treatment and pregnancy outcomes in these cases.Results:A total of 79 monochorionic twin pregnancy with complication were included in the study.The age of pregnant women is between 20 and 41 years,with an average age of 29.8±4.9 years.In 79 cases of complicated twin pregnancy,60 cases of imonochorionic diamniotic twins,18 cases of monochorionic monoamniotic twins,1 case could not determine chorionicity.Including 36 cases of twin-twin transfusion syndrome,21 cases of selective intrauterine growth restriction(1 case of monoamniotic twin),7 cases of twin reversed arterial perfusion sequence(3 cases of single amniotic sac twin).14 cases of conjoined twins.Thirty-seven cases of TTTS were monochorionic diamniotic twins,3 cases were stage ?,10 cases were stage ?,16 cases were stage ?,4 cases were stage ?,and 3 cases were stage V.Tree cases of stage ? all twins survived.Of the 10 cases of stage?,3 cases were induced.2 cases of both twins survived.One case was diagnosed at 24 weeks,and one of the twins died in 29 weeks.2 cases are inevitable abortion.2 cases underwent selective reduction,and the fetus survived after operation.Of'the 16 cases of stage ?,3 were induced.2 cases were inevitable abortion.4 cases of both twins survived.4 cases had selective reduction,the fetus survived after operation.In 2 cases of amniotic fluid reduction,1 case survived and another died.One case failed to survieve after laser coagulation.Of the 4 cases of stage ?,2 cases were induced.One case of one fetal intrauterine death.1 case was inevitable abortion.Of the 3 cases of stage ?,1 case of both twins died in 21 weeks.One case of one twin died.One case the pregnant woman chose to terminate in 26 weeks.There are 29 fetuses horned.Fourteen(46%)of the newborns had adverse outcomes.A total of 15 cases of umbilical cord insertions were observed,and 7 cases had abnormal umbilical cords insertion.There was no significant difference in the incidence of at least one twin survival and neonatal-related disease in the different stages of ?-? TTTS(P>0.05).There were significant differences in the gestational age between five stages of TTTS(P<0.05).The incidence of one twin survival was higher in the surgical group than in the expectant treatment group,and the difference was statistically significant(P<0.05),but no significant difference in the incidence of neonatal-related diseases between the two groups(P>0.05).The gestational age of the surgical group was significantly smaller than that of the expected treatment group(P<0.05).The length of the extended gestational age in the surgical group was significantly larger than that in the expectant treatment group,and the difference was statistically significant(P<0.05)Of the 21 sIUGR twins,there were 12 case of type 1.7 case of type 11,2 case of type ?.1 case of twins died in 29 weeks,and 1 case of twins died in 33 weeks.The rest survived.19 cases were born in our hospital.Nineteen(50%)of the newborns had adverse outcomes.The average birth weight of type ? large fetuses and small fetuses was smaller than the average birth weight of type ? and type ?,but there was no significant difference between the three types(P>0.05).The difference in birth weight of type ? twins was significantly higher than that of type ? and type ?,but there was no significant difference between the three types(P>0.05).The incidence of neonatal-related diseases of type ? and ? sIUGR was significantly higher than that of type ? sIUGR(P<0.05).There were 7 cases of TRAPS twins.One case was misdiagnosed as a single pregnancy during early pregnancy and was not diagnosed correctly until 31 weeks.One case of monoamniotic twins was misdiagnosed as one of the twins at 17 weeks,and 21 weeks of ultrasound was diagnosed as acardiac twin.The normal fetus was observed in the external hospital after ablation and was born in late pregnancy.One case of monoamniotic twins was diagnosed at 13 weeks and the normal fetus was intrauterine death.One case was diagnosed with acardiac twin in the external hospital at 14 weeks and examine in our department the first time in 31 weeks.In 2 cases,the pregnant woman chose to terminate the pregnancy after diagnosis.One case was diagnosed in 13 weeks and gave birth in late pregnancy.Of the 14 conjoined twins.9 cases of thoraco-omphalopagus.2 cases of omphalopagus,3 cases of cephalopagus,1 case of ischiopagus and 1 cases of fetus in fetus.3 cases had fetal death and 11 had termination of pregnancy after ultrasound diagnosis.Conclusion:1.TTTS mainly occurs in 16-26 weeks of gestation.The survival rate of TTTS twins diagnosed after 26 weeks of pregnancy is high.In this period,ultrasound examination should pay special attention to the potential risk of TTTS.2.?,? type sIUGR compared with type ?,is more prone to neonatal outcomes.Clear classification should be given by ultrasound examination,which is conducive to clinical treatment and counseling.3.Twin reversed arterial perfusion sequence are easily misdiagnosed as one of the single or both twin intrauterine deaths.4.Early pregnancy ultrasound examination can make a clear diagnosis of conjoined twins.PART ? Exploration of Ultrasound Index of Complex Monochorionic Twins in Early PregnancyObjection:The aim of this study was to investigate the relationship between the ultrasound characteristics of monochorionic twin pregnancy and the complications in mid-late pregnancy,such as TTTS and sIUGR,in order to assess the possibility of TTTS and sIUGR as early as possible.Method:From April to December 2018,Pregnant women with a monochorionic twin pregnancy included in the study,who received ultrasound examination of the fetus during the first trimester(11-13+6 weeks)and system ultrasound examination(grade ?)in the Department of Ultrasound,Shenzhen Maternal and Child Health Hospital of Southern Medical University.Close monitoring of monochorionic twin cases and follow-up of twin outcomes.The correlation between normal pregnancy and abnormal pregnancy ultrasound characteristics was analyzed,and the two were compared and analyzed.Results:A total of 28 cases of monochorionic twin pregnancy were included in the study,including 27 diamniotic twins and 1 monoamniotic twin.Pregnant women are 24-40 years old with an average age of 30.8±3.7 years.In the early pregnancy,the gestational age was 11-13+6 weeks,and the average gestational age was 12.5±0.5 weeks.One case was lost,25 cases were naturally conceived,and 2 cases were with assisted reproductive technology.In the end,a total of 16 pregnant women were followed up to production or abortion,including 12 cases of normal twins and 4 cases of complicated twins(including 2 cases of TTTS,1 case of sIUGR,and 1 case of intrauterine death of twins).One case of TTTS showed obvious difference in crown-rump length,NT thickness,amniotic fluid volume,cardiothoracic ratio,abdominal circumference,bladder in early pregnancy.Under observation,it was diagnosed with TTTS at 16 gestation weeks.In the other case,there is a difference between the crown-rump length,NT thickness,and cardiothoracic ratio.However,there is no difference in the amniotic fluid and umbilical cord diameter.The TTTS was diagnosed at 18 weeks of gestation and both fetuses loss in 19 gestation weeks.Both have velamentous placenta.One case of sIUGR twins diagnosed was a monochorionic diamniotic twin.In the early pregnancy,the twins were not significantly diferent in terms of crown-rump length,NT value,amniotic fluid.One of the twins in the mid-pregnancy was diagnosed with selective intrauterine growth restriction.Two female infants were electivcly cesarean section at 29 + 5 week,and their weight was 1240g/690g,respectively.The younger baby was born with mild asphyxia.One of the confirmed twin cases of intrauterine death was a monochorionic diamniotic twin.In early pregnancy,there are no different in terms of crown-rump length,NT value,amniotic fluid,umbilical cord diameter.The surviving fetus was born in 37+4 weeks.Conclusion:When the twins in the early pregnancy have obvious differences in crown-rump length,NT thickness,heart-thoracic ratio,amniotic fluid volume,etc.,they should be alert to the possibility of twin-twin transfusion syndrome.It is necessary to strengthen monitoring for high-risk groups and increase the frequency of ultrasound examination.To achieve early diagnosis and early intervention.It is conducive to pregnant women and their families to consult and choose hospitals with better medical conditions for interventional treatment,improve the survival rate of'perinatal children,and reduce the physical and mental suspect of pregnant women and their families. |
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