探讨单绒毛膜单羊膜囊(MCMA)双胎妊娠的围生结局及其围生期管理。

选择2011年1月至2016年12月，于四川大学华西第二医院妇产科收治的44例MCMA双胎孕妇为研究对象，收集其相应临床资料，采取回顾性分析法对其围生结局进行分析。

本研究中，MCMA双胎妊娠发生率为0.07%(44/61 607)。对44例MCMA双胎妊娠孕妇的研究结果如下。①诊断MCMA双胎妊娠时间：2例直至产时才被诊断为MCMA双胎妊娠，其余42例于孕龄为8^＋3～33^＋1孕周时，被诊断为MCMA双胎妊娠。②妊娠结局：2例孕妇自然流产终止妊娠；13例因死胎或合并胎儿畸形进行引产终止妊娠；10例仅一胎活产分娩，分娩孕龄为31～39^＋5孕周；19例双胎均活产分娩，分娩孕龄为30～36^＋1孕周。③胎儿畸形发生情况：这44例MCMA双胎孕妇妊娠的88例胎儿中，胎儿畸形率为19.3%(17/88)。其中，2对(4例)胎儿为联体双胎，6例为无心畸形，1例为先天性心脏病，6例为其他畸形。④非畸形胎儿的存活情况：71例非畸形胎儿中，孕期死胎发生率为19.7%(14/71)；46例活产儿的出生体重为(1 962.6±474.6)g；新生儿死亡率为4.3%(2/46)，随访存活新生儿迄今生长发育状况均良好。⑤胎盘及脐带检查：临床对44例MCMA双胎妊娠孕妇，于产后检查胎盘，均证实了MCMA的诊断。

MCMA双胎妊娠围生儿患病率及死亡率高，早期诊断MCMA双胎、规范化产前检查、严密监护胎儿情况及适时终止妊娠十分重要。临床加强对MCMA双胎的围生期管理，有助于改善其妊娠结局。

To study the clinical management and perinatal outcomes of monochorionic monoamniotic (MCMA) twin pregnancy.

A retrospective study was performed on the management and perinatal outcomes of 44 cases of MCMA twin pregnancy in Department of Gynecology and Obsterics, West China Second University Hospital, Sichuan University between January 2011 and December 2016.

The incidence of MCMA twin pregnancy in this study was 0.07% (44/61 607). The research results of the 44 cases of MCMA twin pregnancy were as follows. ①Two cases were diagnosed as MCMA twin pregnancy until delivery. Prenatal diagnosis of MCMA twin pregnancy was made in 42 cases, from 8^{+ 3} to 33^{+ 1} gestational weeks. ②The pregnancy outcomes were as follows. Spontaneous abortion occurred in 2 cases and 13 cases were performed induced labour due to fetal demises or fetal congenital malformation. Ten cases were with only one fetus born alive, and their birth gestational ages were 31-39^{+ 5} gestational weeks. And 19 cases were with two fetuses born alive, and their birth gestational ages were 30-36^{+ 1} gestational weeks. ③Among the 88 fetuses born by 44 cases of MCMA twin pregnant women, the incidence of fetal congenital malformation was 19.3% (17/88). And 2 pairs (4 cases) were conjoined twins, 6 cases were acardiac monstrosity, 1 case was congenital heart disease, and 6 cases were other fetal congenital malformations. ④Fetal deaths occurred in 19.7% (14/71) of non-malformed fetuses. A total of 46 cases of neonates were born alive, and the average birth weight was (1 962.6±474.6) g .There were 2 neonatal deaths in 46 liveborn neonates and the neonatal mortality was 4.3% (2/46). The liveborn neonates are being followed up and they are in good health until now. ⑤After delivery, diagnosis of MCMA twin pregnancy was confirmed by placenta examination.

MCMA twins are associated with high antenatal and perinatal mortality rates. Early diagnosis, regular antenatal examination, close fetal surveillance and concerning the appropriate timing of delivery are all critical. Strengthening the clinical management of MCMA twin pregnancy is helpful to improve the pregnancy outcomes.