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目的探讨产前超声对双胎反向动脉灌注序列(TRAP)的诊断价值。方法回顾分析产前超声诊断并经引产或出生后证实的10例TRAP的超声表现及妊娠结局。结果 10例TRAP中,7例单绒毛膜双羊膜囊双胎,2例单绒毛膜单羊膜囊双胎,1例双绒毛膜3羊膜囊3胎;泵血儿解剖结构9例基本正常,1例右足内翻;3例合并胎儿生长受限,3例三尖瓣反流,4例羊水过多;10例无心畸胎均伴有严重解剖结构异常,9例未见明显心脏结构及胎心搏动,1例可见胎心搏动,但心脏结构不完整,彩色多普勒超声显示脐动脉反向灌注。无心畸胎2例血流自然阻断,泵血儿结局均良好;2例迅速增大,1例近孕32周泵血儿出现心衰,促肺成熟后经阴道顺娩,结局良好,1例因无心畸胎太大行剖宫产,泵血儿出生后窒息死亡;6例选择性引产,1例泵血儿于引产前宫内死亡。结论 CDFI显示无心畸胎血循环呈脐动脉反向灌注是TRAP的特征性改变,产前超声检查可明确诊断,对预后判断、治疗方案和分娩时机选择有重要应用价值。
Objective To investigate the value of prenatal ultrasound in the diagnosis of twin reverse arterial perfusion (TRAP). Methods We retrospectively analyzed the ultrasound findings and pregnancy outcomes of 10 cases of TRAP diagnosed by prenatal ultrasound and confirmed by induction of labor or after birth. Results In the 10 cases of TRAP, 7 cases of single chorioalmond twin embryos, 2 cases of single chorionic single amniotic sac twins and 1 cases of double chorioamnionum 3 amniotic sacs. The anatomic structure of pump blood was normal in 9 cases and 1 Cases of right foot varus; 3 cases of fetal growth restriction, 3 cases of tricuspid regurgitation, 4 cases of polyhydramnios; 10 cases without heart teratogenic abnormalities were accompanied by severe anatomic abnormalities in 9 cases without obvious heart structure and fetal heart rate Beating, one case showed fetal heart beat, but the heart structure is not complete, color Doppler ultrasound showed umbilical artery reverse perfusion. Two cases of no cardiac teratogenicity were blocked by blood flow naturally, and the results of pump blood were all good. Two cases were rapidly increased. One case had heart failure at pumping 32 weeks after pregnancy. Cases of unwanted cardiac teratogenic too cesarean section, pump blood died of suffocation after birth; 6 cases of selective induction of labor, 1 case of bleeding in the uterus before induction of labor intrauterine death. Conclusions CDFI shows that reverse blood perfusion of umbilical artery is a characteristic change of TRAP in blood circulation without preconditioning. Prenatal ultrasonography can confirm the diagnosis and has important value in judging prognosis, treatment plan and timing of delivery.