单绒毛膜双羊膜囊双胎并发症的早期预测

尤瑾钰; 宋丽珠; 罗艳敏

doi:10.19538/j.fk2025020108

PDF(902 KB)

中国实用妇科与产科杂志 ›› 2025, Vol. 41 ›› Issue (2) : 167-172. DOI: 10.19538/j.fk2025020108

专题笔谈

单绒毛膜双羊膜囊双胎并发症的早期预测

作者信息 +

Early prediction of complications of monochorionic diamniotic twin pregnancy

Author information +

文章历史 +

摘要

单绒毛膜双羊膜囊（monochorionic diamniotic，MCDA）双胎妊娠为高危妊娠，孕期可进展为选择性胎儿生长受限（selective fetal growth restriction，sFGR）等特殊并发症，不良妊娠结局发生率高。文章归纳总结了MCDA双胎妊娠特殊并发症现有预测指标及其预测效能，探讨未来的发展方向。

Abstract

Monochorionic diamniotic（MCDA）twin pregnancy is considered as high-risk pregnancy，which can progress during gestation to specific MCDA complications such as selective fetal growth restriction，and it has high incidence of adverse pregnancy outcomes. Here，we summarize the existing predictive indicators for specific complications associated with MCDA twin pregnancies，and investigate the direction for future development.

导出引用

尤瑾钰, 宋丽珠, 罗艳敏. 单绒毛膜双羊膜囊双胎并发症的早期预测[J]. 中国实用妇科与产科杂志. 2025, 41(2): 167-172 https://doi.org/10.19538/j.fk2025020108

Jin-yu YOU, Li-zhu SONG, Yan-min LUO. Early prediction of complications of monochorionic diamniotic twin pregnancy[J]. Chinese Journal of Practical Gynecology and Obstetrics. 2025, 41(2): 167-172 https://doi.org/10.19538/j.fk2025020108

中图分类号： R714.23

参考文献

列表( 原文顺序 | 文献年度倒序 | 文中引用次数倒序 ) 可视化分析

[1]	Royal College of Obstetricians & Gynaecologists. Management of monochorionic twin pregnancy:Green-top guideline No. 51[J]. BJOG, 2017, 124(1):e1-e45. DOI:10.1111/1471-0528.14188. 本文引用 [1]

[2]

Buca

, Pagani

, Rizzo

, et al. Outcome of monochorionic twin pregnancy with selective intrauterine growth restriction according to umbilical artery Doppler flow pattern of smaller twin:systematic review and meta-analysis[J]. Ultrasound Obstet Gynecol, 2017, 50(5):559-568. DOI:10.1002/uog.17362.

本文引用 [1]

[3]	El Emrani S, Groene S G, Verweij E J, et al. Gestational age at birth and outcome in monochorionic twins with different types of selective fetal growth restriction:A systematic literature review[J]. Prenatal Diagnosis, 2022, 42(9):1094-1110. DOI:10.1002/pd.6206. 本文引用 [1]

[4]	Spekman J A, Israëls J, de Vreede I, et al. Reduced lung function during childhood in identical twins with discordant fetal growth:a cohort study[J]. EClinicalMedicine, 2024,72:102600. DOI:10.1016/j.eclinm.2024.102600. 本文引用 [1]

[5]	Alba AC, Agoritsas T, Walsh M, et al. Discrimination and calibration of clinical prediction models:users’ guides to the medical literature[J]. JAMA, 2017, 318(14):1377-1384. DOI:10.1001/jama.2017.12126. 本文引用 [2]

[6]	Shreffler J, Huecker MR. Diagnostic testing accuracy:sensitivity,specificity,predictive values and likelihood ratios[M]. Treasure Island (FL): StatPearls Publishing, 2025. 本文引用 [2]

[7]	Lee HS, Abbasi N, Van Mieghem T, et al. Guideline No. 440:management of monochorionic twin pregnancies[J]. J Obstet Gynaecol Can, 2023, 45(8):587-606.e8. DOI:10.1016/j.jogc.2023.05.018. 本文引用 [3]

[8]	中国妇幼保健协会双胎妊娠专业委员会. 选择性胎儿宫内生长受限诊治及保健指南(2020)[J]. 中国实用妇科与产科杂志, 2020, 36(7):618-625. DOI:10.19538/j.fk2020070112. 本文引用 [2]

[9]	Memmo A, Dias T, Mahsud-Dornan S, et al. Prediction of selective fetal growth restriction and twin-to-twin transfusion syndrome in monochorionic twins[J]. BJOG, 2012, 119(4):417-421. DOI:10.1111/j.1471-0528.2011.03250.x. 本文引用 [11]

[10]	Mackie FL, Whittle R, Morris RK, et al. First-trimester ultrasound measurements and maternal serum biomarkers as prognostic factors in monochorionic twins:a cohort study[J]. Diagn Progn Res, 2019,3:9. DOI:10.1186/s41512-019-0054-9. 本文引用 [4]

[11]	Fratelli N, Prefumo F, Fichera A, et al. Nuchal translucency thickness and crown rump length discordance for the prediction of outcome in monochorionic diamniotic pregnancies[J]. Early Hum Dev, 2011, 87(1):27-30. DOI:10.1016/j.earlhumdev.2010.09.375. 本文引用 [7]

[12]

Zhu

, Bian

, Liao

, et al. Retrospective validation of 11-13 weeks’ gestation ultrasound characteristics as predictive tools for twin-twin transfusion syndrome and selective intrauterine growth restriction in monochorionic diamniotic twin pregnancies[J]. Ann Transl Med, 2021, 9(18):1417. DOI:10.21037/atm-21-3826.

本文引用 [16]

[13]

Mogra

, Saaid

, Tooher

, et al. Prospective validation of first-trimester ultrasound characteristics as predictive tools for twin-twin transfusion syndrome and selective intrauterine growth restriction in monochorionic diamniotic twin pregnancies[J]. Fetal Diagn Ther, 2020, 47(4):321-327. DOI:10.1159/000504049.

本文引用 [10]

[14]

Zhu

, Wang

, Pan

, et al. Retrospective validation of ultrasound characteristics at 19-24 weeks as predictive tools for selective intrauterine growth restriction in monochorionic diamniotic twin pregnancies:a diagnostic study[J]. Ann Transl Med, 2022, 10(14):760. DOI:10.21037/atm-22-3089.

本文引用 [1]

[15]	Kalafat E, Thilaganathan B, Papageorghiou A, et al. Significance of placental cord insertion site in twin pregnancy[J]. Ultrasound Obstet Gynecol, 2018, 52(3):378-384. DOI:10.1002/uog.18914. 本文引用 [2]

[16]	Huang N, Chen W, Jiang H, et al. Metabolic dynamics and prediction of sFGR and adverse fetal outcomes:a prospective longitudinal cohort study[J]. BMC Med, 2023, 21(1):455. DOI:10.1186/s12916-023-03134-9. 本文引用 [1]

[17]	Yinon Y, Ben Meir E, Berezowsky A, et al. Circulating angiogenic factors in monochorionic twin pregnancies complicated by twin-to-twin transfusion syndrome and selective intrauterine growth restriction[J]. Am J Obstet Gynecol, 2014, 210(2):141.e1-141.e7.DOI:10.1016/j.ajog.2013.09.022. 本文引用 [2]

[18]	Mackie FL, Hall MJ, Morris RK, et al. Early prognostic factors of outcomes in monochorionic twin pregnancy:systematic review and meta-analysis[J]. Am J Obstet Gynecol, 2018, 219(5):436-446. DOI:10.1016/j.ajog.2018.05.008. 本文引用 [2]

[19]	Zipori Y, Reidy K, Gilchrist T, et al. The outcome of monochorionic diamniotic twins discordant at 11 to 13+6 weeks’ gestation[J]. Twin Res Hum Genet, 2016, 19(6):692-696. DOI:10.1017/thg.2016.81. 本文引用 [6]

[20]	Matias A, Montenegro N, Loureiro T, et al. Screening for twin-twin transfusion syndrome at 11-14 weeks of pregnancy:the key role of ductus venosus blood flow assessment[J]. Ultrasound Obstet Gynecol, 2010, 35(2):142-148. DOI:10.1002/uog.7533. 本文引用 [5]

[21]	Anh ND, Thuong PH, Sim NT, et al. Maternal vascular endothelial growth factor receptor and interleukin levels in pregnant women with twin-twin transfusion syndrome[J]. Int J Med Sci, 2021, 18(14):3206-3213. DOI:10.7150/ijms.61014. 本文引用 [1]

[22]	Fox CE, Sekizawa A, Pretlove SJ, et al. Maternal cell-free messenger RNA in twin pregnancies:the effects of chorionicity and severe twin to twin transfusion syndrome (TTTS)[J]. Acta Obstet Gynecol Scand, 2012, 91(10):1206-1211. DOI:10.1111/j.1600-0412.2012.01507.x. 本文引用 [1]

[23]	Miura K, Higashijima A, Miura S, et al. Predominantly placenta-expressed mRNAs in maternal plasma as predictive markers for twin-twin transfusion syndrome[J]. Prenat Diagn, 2014, 34(4):345-349. DOI:10.1002/pd.4307. 本文引用 [1]

[24]	Yang Y, Wen L, Han TL, et al. Twin-twin transfusion syndrome is associated with alterations in the metabolic profile of maternal plasma in early gestation:a pilot study[J]. Prenat Diagn, 2021, 41(9):1080-1088. DOI:10.1002/pd.5933. 本文引用 [2]

[25]	Mahony R, Mulcahy C, McAuliffe F, et al. Fetal death in twins[J]. Acta Obstet Gynecol Scand, 2011, 90(11):1274-1280. DOI:10.1111/j.1600-0412.2011.01239.x. 本文引用 [1]

[26]	Litwinska E, Syngelaki A, Cimpoca B, et al. Intertwin discordance in fetal size at 11-13 weeks’ gestation and pregnancy outcome[J]. Ultrasound Obstet Gynecol, 2020, 55(2):189-197. DOI:10.1002/uog.21923. 本文引用 [1]

[27]	Zhang A, Stolk TT, Lopriore E, et al. Second-trimester abdominal circumference discordance and adverse perinatal outcomes in monochorionic twins[J]. J Matern Fetal Neonatal Med, 2022, 35(25):7316-7321. DOI:10.1080/14767058.2021.1947227. 本文引用 [2]

[28]	中国妇幼保健协会双胎妊娠专业委员会. 双胎贫血-红细胞增多序列征诊治及保健指南(2020)[J]. 中国实用妇科与产科杂志, 2020, 36(9):818-824. DOI:10.19538/j.fk2020090108. 本文引用 [1]

[29]	Hiersch L, Eitan M, Ashwal E, et al. Amniotic fluid discordance in monochorionic diamniotic twin pregnancies is associated with increased risk for twin anemia-polycythemia sequence[J]. Prenat Diagn, 2016, 36(12):1099-1103. DOI:10.1002/pd.4939. 本文引用 [1]

[30]	Wang X, Li L, Zhao Y, et al. Longer distance between umbilical cord insertions is associated with spontaneous twin anemia polycythemia sequence[J]. Acta Obstet Gynecol Scand, 2021, 100(2):229-234. DOI:10.1111/aogs.13991. 本文引用 [1]

[31]	Chang YL, Wang TH, Chang SD, et al. Increased autophagy in the placental territory of selective intrauterine growth-restricted monochorionic twins[J]. Prenat Diagn, 2013, 33(2):187-190. DOI:10.1002/pd.4040. 本文引用 [1]

[32]	Meng XL, Yuan PB, Wang XJ, et al. The proteome landscape of human placentas for monochorionic twins with selective intrauterine growth restriction[J]. Genomics Proteomics Bioinformatics, 2023, 21(6):1246-1259. DOI:10.1016/j.gpb.2023.03.002. 本文引用 [1]

[33]	Shi D, Zhou X, Cai L, et al. Placental DNA methylation analysis of selective fetal growth restriction in monochorionic twins reveals aberrant methylated CYP11A1 gene for fetal growth restriction[J]. FASEB J, 2023, 37(10):e23207. DOI:10.1096/fj.202300742R. 本文引用 [1]

[34]	Roifman M, Choufani S, Turinsky AL, et al. Genome-wide placental DNA methylation analysis of severely growth-discordant monochorionic twins reveals novel epigenetic targets for intrauterine growth restriction[J]. Clin Epigenetics, 2016,8:70. DOI:10.1186/s13148-016-0238-x. 本文引用 [1]

[35]	He Z, Lu H, Luo H, et al. The promoter methylomes of monochorionic twin placentas reveal intrauterine growth restriction-specific variations in the methylation patterns[J]. Sci Rep, 2016,6:20181. DOI:10.1038/srep20181. 本文引用 [1]

[36]	De Borre M, Che H, Yu Q, et al. Cell-free DNA methylome analysis for early preeclampsia prediction[J]. Nat Med, 2023, 29(9):2206-2215. DOI:10.1038/s41591-023-02510-5. 本文引用 [1]

[37]	Rasmussen M, Reddy M, Nolan R, et al. RNA profiles reveal signatures of future health and disease in pregnancy[J]. Nature, 2022, 601(7893):422-427. DOI:10.1038/s41586-021-04249-w. 本文引用 [1]