摘要
目的 探讨双胎之一完全性葡萄胎 (atwinpregnancyconsistingofacompletemoleandcoexistingfetus,CMCF)的产前诊断及处理。方法 回顾性分析 2例CMCF的临床资料。结果 第 1例患者在孕 10周时 ,B超发现胎儿与葡萄胎胎盘共存 ,患者要求终止妊娠 ,刮宫物间期细胞荧光原位杂交 (fluorescentinsituhybridization ,FISH)和核型分析提示 ,胎儿与葡萄胎均为二倍体 ,证实为CMCF。第 2例患者在孕 2 1周时 ,B超发现胎儿与葡萄胎胎盘共存 ,B超引导下经腹壁绒毛活组织检查 (活检 )和羊膜腔穿刺 ,葡萄胎和羊水的间期细胞FISH和核型分析提示 ,胎儿与葡萄胎均为二倍体 ,证实为CMCF双胎之一完全性葡萄胎 ,患者继续妊娠 ,在孕 2 8周时胎膜早破 ,因继发感染而行剖宫产终止妊娠 ,胎儿存活 ,胎盘、新生儿外周血的核型分析结果与产前诊断相符。结论 产前一旦发现胎儿与葡萄胎胎盘共存 ,应立即进行CMCF和部分性葡萄胎 (partialhydatidiformmole,PHM)的鉴别 ,如果绒毛和羊水行间期细胞FISH和核型分析为二倍体 ,则为CMCF ,是否继续妊娠 ,需采取个体化原则 ;如果为三倍体 ,则为部分性葡萄胎 ,应及时终止妊娠。
Objective To discuss the differential diagnosis of the hydatidiform mole and a coexisting fetus,to study the prenatal diagnosis and the clinical management of a twin pregnancy consisting of a complete mole and coexisting fetus(CMCF). Methods Two cases of CMCF were reported retrospectively. Results In the first case,the hydatidiform mole and a coexisting fetus was found by B mode ultrasound at the 10th gestational week,the patient asked to terminate the pregnancy. The interphase FISH and karyotype analysis of the normal villi and the mole showed both of them were diploid,thus the CMCF was diagnosed. In the second case,the hydatidiform mole and a coexisting fetus was found by B mode ultrasound at the 21st gestational week. Transabdominal chorionic villi sampling and amniocentesis was performed,interphase FISH and karyotype analysis of the mole and the amniotic fluid showed both of them were diploid,thus the CMCF was diagnosed prenatally. The pregnancy was continued and premature rupture of membrane happened at the 28th gestational week,the cesarean section was performed. The neonate was healthy. The karyotype analysis of the placenta and the neonate was accordant with the prenatal diagnosis. Conclusions As long as the hydatidiform mole and a coexisting fetus was found the prenatal diagnosis must be performed in order to differentiate the CMCF and the partial hydatidiform mole(PHM). The transabdominal chorionic villi sampling and the amniocentesis were ideal methods,interphase FISH and karyotype analysis of the mole and the amniotic fluid should be performed. If both of them were diploid,the CMCF could be diagnosed. The clinical management of CMCF should be done individually.If both of them were triploid,the PHM could be diagnosed.
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
2003年第10期595-598,共4页
Chinese Journal of Obstetrics and Gynecology
关键词
双胎妊娠
完全性葡萄胎
产前诊断
预后
鉴别诊断
Twins
Hydatidiform mole
In situ hybridization,fluorescence
Karyotypping
Prenatal diagnosis
