双胎妊娠之一胎死宫内原因及处理17例临床分析

Clinical Analysis of 17 Cases of Twin Pregnancy with One Fetal Intrauterine Death

目的探讨双胎妊娠之一胎死宫内的原因、临床处理及预后。方法回顾性分析1995年2月-2009年5月广州番禺中心医院双胎妊娠之一胎死宫内的病例共17例临床资料。结果双胎一胎宫内死亡的发生率为2.99%。孕28周前发现一胎宫内死亡者3例,平均期待治疗102.8 d,平均分娩孕周为36+5周;孕28周后发现一胎宫内死亡者期待治疗12例,平均期待治疗13.2 d,平均分娩孕周为35+1周。仅1例新生儿发生轻度窒息。无一例孕妇发生凝血功能障碍。早产、子痫前期和胎膜早破发生率高。胎儿畸形是胎死宫内的重要原因。结论双胎妊娠一胎宫内死亡后可采取期待治疗,严密监测存活胎儿宫内状况,尽量延长孕周,可提高存活胎儿的生存质量。

Objective To study the cause, clinical treatment, and prognosis of twin pregnancy with one fetal intrauterine death. Methods 17 cases of twin pregnancy with one fetal intrauterine death from February 1995 to May 2009 in Panyu Central Hospital were analyzed. Results The rate of twin pregnancy with one fetal intrauterine death was 2.99% （ 17/568）. Of the 17 cases, 3 patients were found one fetal death within 28 weeks of pregnancy;their pregnancy were terminated after averagely 102.8 days of expectant treatment;average termination time were 36 ＋5 weeks. 12 patients were found intrauterine death after 28 weeks of preg- nancy deal with expectant treatment; their pregnancy were terminated after averagely 13.2 days; average termination time was 35 ~ t weeks. Only 1 premature delivery cases had mild asphyxia. Of the 17 cases, no coagulation disturbance occurred. The most common complications were the premature birth and preeclampsia and premature rupture of membranes. Congenital malformation was the main reason to the intrauterine fetal death. Conclusion On condition that the intrauterine surviving fetal and maternal coagulation function were watched and maternal complications and accompanying diseases were dealt with, expectant treatment was an effective way of treating twin pregnancy with one fetal intrauterine death.