非TTTS单绒毛膜双胎的胎盘特点与胎儿生长发育相关性研究
发布时间：2018-12-10 12:06
【摘要】：研究目的 近年来,双胎妊娠发生率明显上升。据统计,其中约1/4为单绒毛膜双胎,3/4为双绒毛膜双胎。而由于胎盘表面广泛血管吻合支的存在,从而导致包括双胎输血综合征(TTTS)、选择性宫内生长受限(sIUGR)、双胎反向动脉灌注序列征(TRAPS)、双胎贫血-多血序列征(TAPS)、双胎之一宫内死亡等并发症的发生,使得单绒毛膜双胎的母儿不良结局发生率增加。对于TTTS,国内外做了大量研究,胎盘间的动脉-静脉吻合支及胎盘份额不均等被认为是发病的重要原因,且动脉-静脉吻合支为主要原因；但是近年有研究发现,在sIUGR及正常MC双胎等非TTTS中有更为复杂的血管吻合关系,这一点可能在胎盘份额不均等的双胎胎儿宫内生长发育过程中对较小胎盘的胎儿起到保护作用,延缓了双胎生长发育不一致的进展。本文通过对非TTTS单绒毛膜双胎的胎盘血管进行灌注,并对既往相关研究进行回顾,以了解非TTTS单绒毛膜双胎的胎盘特点(包括胎盘份额差异、脐带插入位置、脐带血管数量、血管吻合支数量及直径等),验证其对胎儿生长发育产生的影响,帮助理解这些常见并发症的发病机制以及临床表现。 研究方法 选择研究对象为自2013年7月至2014年2月期间,于山东省立医院产科分娩的单绒毛膜双胎病例,其中需要排除的为确诊为TTTS以及双绒毛膜双胎妊娠的病例。对其胎盘以有色染料灌注后拍摄平面图片,并对胎盘份额、脐带附着方式、血管吻合支的数量、来源以及分娩孕周、产前B型超声结果、新生儿出生体重、新生儿Apgar评分等数据进行记录和分析。 研究结果 灌注成功的样本共有11例。 11个样本中双胎间胎盘份额差异平均为32.73%±20.22%；胎盘份额差异≥20%共7例(63.64%)。 在11个胎盘的22个附着点中,脐带中央型附着为12个(54.55%),球拍状胎盘(边缘型)为3个(13.64%),帆状胎盘的为7个(31.82%)；其中两个中央附着的2例(18.18%),一个中央附着一个非中央附着的8例(72.73%),两个非中央附着的1例(9.09%)。 可观察到明显的动脉-动脉(A-A)吻合支的为9例(81.82%),平均直径为0.16cm±0.11。 新生儿出生体重差异与胎盘份额差异之间存在显著正相关关系,与动脉-动脉吻合支之间未发现明显相关性；新生儿出生体重差异越大,帆状胎盘发生率越高。 研究结论 通过胎盘灌注研究与文献回顾表明,存在新生儿出生体重差异的单绒毛膜双胎有其独特的胎盘特点,以胎盘份额不均等、高帆状胎盘率为特征,研究中未发现血管吻合支与新生儿生长发育的明显相关性。
[Abstract]:Objective to increase the incidence of twin pregnancy in recent years. According to statistics, about 1 / 4 of them are single chorionic twins and 3 / 4 are double chorionic twins. The presence of extensive vascular anastomoses on the surface of the placenta leads to (TTTS), selective intrauterine growth restriction, (sIUGR), reverse arterial perfusion sequence sign, (TRAPS), twin anemia and multiple blood sequence sign (TAPS), including twin transfusion syndrome. Complications such as intrauterine death increased the incidence of maternal and fetal adverse outcomes in single chorionic twins. A large number of studies have been done on TTTS, both at home and abroad. The arterio-venous anastomoses between placenta and the uneven placental share are considered to be the important causes of the disease, and the arterial-venous anastomosis branch is the main cause. However, recent studies have found that there are more complex vascular anastomoses in non-TTTS, such as sIUGR and normal MC twins, which may play a protective role in the intrauterine growth and development of twins with unequal placental shares. The growth and development of twin twins were delayed. Placental vessels were perfused in non TTTS single chorionic twins and previous studies were reviewed to understand the placental characteristics of non TTTS single chorionic twins (including placental share differences, umbilical cord insertion location, and the number of umbilical cord blood vessels). The number and diameter of vascular anastomoses were used to verify the effects of vascular anastomosis on fetal growth and development, and to help understand the pathogenesis and clinical manifestations of these common complications. Methods from July 2013 to February 2014, single chorionic twins delivered in the Department of Obstetrics of Shandong Provincial Hospital were selected as subjects, among which the cases diagnosed as TTTS and double chorionic twin pregnancy should be excluded. After the placenta was infused with colored dye, the placenta share, the way of umbilical cord attachment, the number of anastomotic branches, the origin of the placenta, the gestational weeks of delivery, the results of prenatal B-mode ultrasound, and the birth weight of the newborn were taken. Neonatal Apgar score and other data were recorded and analyzed. Results A total of 11 cases were successfully perfused. In 11 samples, the average difference of placental share was 32.73% 卤20.22%, and the difference of placental share was 鈮，
本文编号：2370538
[Abstract]:Objective to increase the incidence of twin pregnancy in recent years. According to statistics, about 1 / 4 of them are single chorionic twins and 3 / 4 are double chorionic twins. The presence of extensive vascular anastomoses on the surface of the placenta leads to (TTTS), selective intrauterine growth restriction, (sIUGR), reverse arterial perfusion sequence sign, (TRAPS), twin anemia and multiple blood sequence sign (TAPS), including twin transfusion syndrome. Complications such as intrauterine death increased the incidence of maternal and fetal adverse outcomes in single chorionic twins. A large number of studies have been done on TTTS, both at home and abroad. The arterio-venous anastomoses between placenta and the uneven placental share are considered to be the important causes of the disease, and the arterial-venous anastomosis branch is the main cause. However, recent studies have found that there are more complex vascular anastomoses in non-TTTS, such as sIUGR and normal MC twins, which may play a protective role in the intrauterine growth and development of twins with unequal placental shares. The growth and development of twin twins were delayed. Placental vessels were perfused in non TTTS single chorionic twins and previous studies were reviewed to understand the placental characteristics of non TTTS single chorionic twins (including placental share differences, umbilical cord insertion location, and the number of umbilical cord blood vessels). The number and diameter of vascular anastomoses were used to verify the effects of vascular anastomosis on fetal growth and development, and to help understand the pathogenesis and clinical manifestations of these common complications. Methods from July 2013 to February 2014, single chorionic twins delivered in the Department of Obstetrics of Shandong Provincial Hospital were selected as subjects, among which the cases diagnosed as TTTS and double chorionic twin pregnancy should be excluded. After the placenta was infused with colored dye, the placenta share, the way of umbilical cord attachment, the number of anastomotic branches, the origin of the placenta, the gestational weeks of delivery, the results of prenatal B-mode ultrasound, and the birth weight of the newborn were taken. Neonatal Apgar score and other data were recorded and analyzed. Results A total of 11 cases were successfully perfused. In 11 samples, the average difference of placental share was 32.73% 卤20.22%, and the difference of placental share was 鈮，
本文编号：2370538
本文链接：https://www.wllwen.com/yixuelunwen/fuchankeerkelunwen/2370538.html
最近更新
教材专著
