漏诊一例晚发型双胎贫血多血质序列征导致双胎之一宫内死亡病例分析

A Case Analysis of a Missed Diagnosis of Late-Onset TAPS Leading to sIUFD

摘要: 胎儿宫内死亡(IUFD)是孕产妇严重的不良结局，而双胎妊娠比单胎妊娠发生IUFD的风险更高。双胎妊娠发生IUFD还与绒毛膜类型有关，单绒毛膜双胎(MCDA)由于两个胎儿共享一个胎盘，它们之间的血管吻合可能导致独特的并发症，从而增加双胎之一胎死宫内(sIUFD)的可能性。如双胎贫血–红细胞增多序列征(TAPS)可在晚孕期才首次出现，是导致妊娠不良结局的高危因素。可通过定期监测并对比两个胎儿的大脑中动脉收缩期峰值流速，敏锐地捕捉到两者间的血流动力学差异从而判断该疾病。通过回顾一例晚发型双胎贫血–红细胞增多症序列(TAPS)导致的sIUFD病例，增强复杂性双胎晚孕期如何进行产前监护的认识。能够实现疾病的早期预警与诊断，为临床干预争取宝贵时间。

Abstract: Intrauterine foetal demise (IUFD) is a severe adverse outcome for pregnant women, and the risk of IUFD is greater in twin pregnancies than in singleton pregnancies. The incidence of IUFD is also related to chronicity. In monochorionic diamniotic (MCDA) fetuses, the two fetuses share a single placenta, while the presence of vascular anastomoses between them can lead to unique complications that increase the likelihood of single intrauterine foetal demise (sIUFD). For instance, Twin Anemia-Polycythemia Sequence (TAPS) may not manifest until the late trimester and is a high-risk factor for adverse pregnancy outcomes. By regularly monitoring and comparing the middle cerebral artery peak systolic velocity (MCA-PSV) of both fetuses, hemodynamic differences between them can be sensitively detected, allowing for the diagnosis of this condition. Surviving cotwins are also at a higher risk of adverse outcomes at the late stage of pregnancy. Through a review of a case of late-onset twin anaemia-polycythaemia sequence (TAPS) leading to sIUFD, we aim to illuminate how to conduct prenatal surveillance in complex twin pregnancies during the late gestational period. This approach facilitates early warning and diagnosis of the disease, thereby securing crucial time for clinical intervention.