目的 探讨HD live技术在单绒毛膜性双胎妊娠产前超声筛查中的临床应用价值。方法 选取于2015年1月至2015年12月在天津市中心妇产科医院行产前超声检查，筛查异常的42例单绒毛膜性双胎妊娠孕妇作为研究对象，所有孕妇均经过胎儿超声检查并随访至分娩，结合胎儿超声筛查与妊娠结局进行总结分析。结果 42例单绒毛膜性双胎妊娠中，单绒双羊双胎39例，单绒单羊双胎3例。39例单绒双羊双胎中，胎儿异常共28例（71.8%，28/39）：其中包括双胎其一合并畸形共12例（30.8%，12/39），双胎其一宫内死胎共6例（15.4%，6/39），双胎输血综合征(twin-to-twin transfusion syndrome，TTTS) 共4例（10.3%，4/39），选择性胎儿宫内生长受限(selective intrauterine growth restriction，sIUGR)共5例（12.8%，5/39），双胎反向动脉灌注序列(twin reversed arterial perfusion sequence，TRAPS) 1例（2.56%，1/39）；胎儿附属物异常共11例（28.2%，11/39），其中包括球拍状胎盘7例（17.9%，7/39），帆状胎盘2例（5.13%，2/39），胎盘血管瘤2例（5.13%，2/39）。3例单绒单羊双胎中，脐带异常2例，胎儿及其附属物合并异常1例。结论 随着HD live超声技术的应用，对于单绒毛膜性双胎妊娠的产前诊断及评估，具有更加早期、精准、直观的优势，对胎儿的早期干预具有积极的临床指导作用。
Objective To explore the value of HD live in pregnant ultrasound screening of monochorionic twin pregnancy. Method Forty-two monochorionic twins from January to December 2015 were enrolled, all cases were abnormal for pregnant ultrasound screening. The result was analyzed with combination of pregnant ultrasound screening and pregnancy outcome after follow-up. Result In forty-two monochorionic twins, 39 cases were MCDA, 3 cases were MCMA. For 39 cases, 28 cases were abnormal (71.8%，28/39), including 12 cases within one fetus malformation (30.8%，12/39), 6 cases within one dead fetus in uterus (15.4%，6/39), 4 TTTS (twin-to-twin transfusion syndrome) cases (10.3%，4/39), 5 sIUGR (selective intrauterine growth restriction) cases (12.8%，5/39), 1 TRAPS (twin reversed arterial perfusion sequence) case (2.56%，1/39). 11 cases were abnormal fetal appendage (28.2%，11/39), including 7 cases within battledore placenta (17.9%，7/39), 2 cases within velamentous placenta (5.13%，2/39), 2 cases within placental hemangioma (5.13%，2/39). For 3 MCMA, 2 cases were abnormal umbilical cords, 1 case was abnormal fetus and fetal appendage. Conclusion For the pregnant diagnosis and evaluation of MC, there as many advantages for the application of HD live, such as more early, accurate and intuitive. It’s of great clinical guidance to effectively execute fetus early intervention.
