背景：这项回顾性研究旨在评估选择性宫内生长受限（sIUGR）的单绒毛膜双胎（MCDA）双胎的临床结局。
方法：MCDA双胞胎，sIUGR和非sIUGR，纳入2016年至2019年在我院接受期待管理。根据脐动脉多普勒评估将sIUGR胎儿分为三种类型。非sIUGR被视为对照组。结果是妊娠结局和产妇并发症。
结果：包括43个sIUGR（I型：23；II型：14和III型：6）和282个非sIUGR胎儿。sIUGR组的出生明显较早，双胞胎的出生体重较低，更大的双胞胎间重量差异，双胞胎的阿普加分数较低，并且子宫内胎儿死亡（IUFD）高于非sIUGR组（均p<0.001）。与I型和III型组相比，sIUGRII型组中发现了相同的趋势。显著降低妊娠期糖尿病发病率（p=0.01）和胎盘重量（p<0.001），胎盘脐带插入异常的比例较高（p<0.001），和超声多普勒监测指标(p=0.006)发现sIUGR组比非sIUGR组。
结论：患有sIUGR的MCDA双胞胎比非sIUGR组的结局较差。多普勒询问是胎儿结局的有用临床标记。
BACKGROUND: This retrospective study aimed to evaluate clinical outcomes of monochorionic diamniotic (MCDA) twins with selective intrauterine growth restriction (sIUGR).
METHODS: MCDA twins, either sIUGR and non-sIUGR, underwent expectant management from 2016 to 2019 in our hospital were included. sIUGR fetuses were classified into three types according to umbilical artery Doppler assessment. Non-sIUGR were considered as the control group. Outcomes were pregnancy outcomes and maternal complications.
RESULTS: Forty-three sIUGR (type I: 23; type II: 14, and type III: 6) and 282 non-sIUGR fetuses were included. The sIUGR group had a significantly earlier birth, lower birth weight of the twins, larger inter-twin weight difference, lower Apgar score of the twins, and higher intrauterine fetal death (IUFD) than the non-sIUGR group (all p < 0.001). The same trend was found in the sIUGR type II group compared to type I and III groups. A significantly lower gestational diabetes rate (p = 0.01) and placenta weight (p < 0.001), and higher proportions of abnormal placental umbilical cord insertion (p < 0.001), and ultrasound Doppler monitoring indicators (p = 0.006) were found in the sIUGR group than the non-sIUGR group.
CONCLUSIONS: The MCDA twins with sIUGR showed poorer outcomes than the non-sIUGR group. Doppler interrogation was a useful clinical marker for fetal outcome.
