Clinical Analysis Of 24 Cases Of SIUGR In Monochorionic Diamniotic Twin

Objective:To discuss the diagnosis and treatment methods,pregnancy outcomes and perinatal conditions of selective intra-uterine growth restriction in monochorionic diamniotic twins.Methods:Retrospective analysis of 24 cases of monochorionic diamniotic twin pregnancies affected by selective intra-uterine growth restriction(sIUGR)in the First Affiliated Hospital of Kunming Medical University from October 2016 to February 2019.The 24 cases of sIUGR were selected as research group,and according to the the classification of umbilical artery Doppler divided into 11 cases of type I,4 cases of type II,and 9 cases of type III.In addition,42 cases of uncomplicated monochorionic diamniotic(MCDA)twin pregnancies were selected as the control group.The outcomes and prognosis of neonatal between the two groups and the three types of sIUGR were analyzed and compared.Results:The rate of abnormal placental cord insertion in the sIUGR group was higher than that in the control group,and the average gestational week at delivery in the sIUGR group was earlier than the control group;the average birth weight of the small fetus and the larger fetus in the sIUGR group were lower than those in the control group,and the difference in birth weight of the twins between the sIUGR group was significantly higher than that in the control group(P<0.05).Mild cerebral injury occurred in 13 newborns in the control group(13/84,15.5%),while 25 newborns in the sIUGR group(25/48,52.1%)developed mild cerebral injury was lower than that of sIUGR group(P<0.05);and the NICU rate of sIUGR group was higher than that of the control group(P<0.05).There were 4 neonatal dead in the sIUGR group and 2neonatal dead in the control group,the difference was not statistically significant(P>0.05).Among the 24 cases with MCDA twins affected by sIUGR,which was divided into type I(11 cases),type II(4 cases)and type 111(9 cases);among the three types,the birth weight of large fetus in type I was higher than that of type II and type?,and the birth weight of small fetus in type I was also higher than that of type II and type ?,the difference was both statistically significant(P<0.05).There were no significant differences in birth weight of lager fetus in type II and type?sIUGR,as the same in small fetus(P>0.05).Compared the difference in birth weight of twins among the three types,type I was the smallest,which was lower than that of type II and type III,and the difference was both statistically significant(P<0.05);and in the difference of birth weight between type II and type III there was no significant difference(P>0.05).The gestational weeks at delivery in type I was larger than type II,and type I were also greater than in type III,the difference was both statistically significant(P<0.05);and the gestational weeks at delivery in type II and type III were compared the difference was not statistical significance(P>0.05).There was a statistically significant difference in mild cerebral injury among three types of sIUGR(P<0.05);The rate of mild cerebral injury in type I was lower than that of type II(P<0.05),and there was no significant difference in mild cerebral injury between type I and type III,so as the type II and type III(P>0.05);and there was no significant difference in mild cerebral injury between large fetus and small fetus in sIUGR group(P>0.05).In the sIUGR group,20 pair neonatals survived,and 4 newborns(6.25%)died in perinatal period;diagnosed as sIUGR before 26 weeks the incidence of neonatal mortality was higher than that of diagnosed after 26 weeks(P<0.05).There was no significant difference in neonatal mortality among three types(P>0.05).Conclusions:?:The rate of abnormal placental cord insertion in the sIUGR group is higher than uncomplicated MCDA group,and the delivery week in sIUGR group is significantly smaller than the uncomplicated MCDA group;the incidence of mild cerebral injury in uncomplicated MCDA neonatal is lower than that in sIUGR group.?:Diagnosed as sIUGR before 26 weeks,the neonatal mortality is higher than the case diagnosed after 26 weeks;?:Among the three types of sIUGR,the fetals birth weight of type II and type III was both lower than that of type I,while the type II had the lowest birth weight;the gestational week at delivery in type ? was the earliest among the three types.