影响双胎之一胎死宫内母儿预后的相关因素分析

Single fetal death in twin pregnancies:analysis of the risk factors related to maternal and neonatal prognosis

目的探讨影响双胎之一胎死宫内母儿预后的相关因素。方法对在我院分娩的13例双胎之一胎死宫内的临床资料进行回顾性分析。结果双胎之一胎死宫内的发生率占双胎的4.17%。单卵双胎6例,双卵双胎7例,胎儿死因中双胎输血综合征(TTTS)4例。母儿结局:晚期流产2例,早产6例,足月产5例。围生儿中小于胎龄儿2例,死亡2例。孕产妇均未发生弥散性血管内凝血(DIC)。一胎于妊娠12～34周死亡者或单卵双胎者,其存活胎婴儿病率增加。TTTS导致的一胎死宫内者,另一胎婴儿丢失率显著增加。孕34周前终止妊娠者围生儿死亡率显著增加。结论双胎之一胎死宫内后对母体的凝血功能影响不大。胎婴儿不良结局可能与双胎类型、胎死宫内的原因、一胎死宫内的时间及终止妊娠的孕周有关。

Objective To explore the risk factors related to maternal and neonatal outcomes of single fetal death in twin pregnancies. Methods Thirteen single fetal deaths in twin pregnancy from January 1992 to December 2005 were analyzed retrospectively. Results During the study period, 4.17% of the twin pregnancies were complicated by the death of one fetus. There were six monozygotic twins, the other seven were dizygotic twins. Among the total cases, there were four twin to twin transfusion syndromes （TTTS）. Two late abortions, six preterm labors and five term labors occurred. No disseminated intravascular coagulation （DIC） was found in the mothers. Among the perinatal births two were small for gestational age and two died. The morbidity of the living fetus was markedly increased in single fetal in 12-34weeks or those in monozygotic twins. TITS resulted in higher mortality of the surviving twin. Perinatal mortality was significantly higher in pregnancy terminated before 34weeks than those after 34weeks. Conclusions Single fetal death in twin pregnancy has almost no effect on maternal coagulation function. The poor prognosis of the surviving twins may be related to the type of twin pregnancy, the cause of single fetal death, the time of single fetal death and the term/nation of pregnancy-before 34weeks.