双胎妊娠一胎宫内死亡18例临床分析

18 cases of Twin Pregnancy Complicated by Single Intrauterine Fetal Death

目的:探讨双胎妊娠中一胎宫内死亡的原因、对母亲和存活胎儿的影响及临床处理方法。方法:对2001年1月至2011年10月分娩的双胎妊娠之一胎宫内死亡的18例产妇临床资料进行回顾性分析。结果:双胎妊娠一胎宫内死胎的发生率占双胎的1.08%,其中单绒毛膜双羊膜囊双胎(monochorionic-diamniotic twin,MCDA)11例(61.11%),双绒毛膜双羊膜囊双胎(dichorionic-diamniotic twin,DCDA)7例(38.89%)。胎儿死因:胎盘脐带因素3例(16.67%),胎儿畸形1例(5.56%),妊娠并发症3例(16.67%),双胎输血综合征(twin-twin transfusion syndrome,TTTs)3例(16.67%),宫内感染3例(16.67%),不明原因5例(27.78%)。另一胎选择剖宫产者13例,阴道分娩3例。双胎一胎死亡后对母体的凝血功能影响不大(P>0.05)。结论:单绒毛膜双胎较双绒毛膜双胎母儿结局存在差别;双胎一胎宫内死亡对母体及存活儿有一定影响。对于孕周小,胎儿尚不成熟的病例,可严密监测存活胎儿宫内情况,行期待治疗延长孕龄至足月再分娩。

Objective： To investigate the cause and factors of the mother and fetus survival in single intrauterine fetal death complicated by twin pregnancy and clinical treatments.Methods： To collect 18 cases of twin pregnancy complicated by single intrauterine fetal death in our hospital from January 2001 to October 2011 and their clinical data were retrospectively analyzed.Results： Single intrauter-ine fetal death accounted for 1.08% in twin pregnancy,in which 11 cases（61.11%） were monochorionic-diamniotic twin（MCDA）,and 7 cases dichorionic-diamniotic twin（DCDA）（38.89%）.The cause of fetal death： 3 cases of Placental umbilical cord factor（16.67%）,1 case of fetal malformation（5.56%）,3 cases pregnancy complications（16.67%）,3 cases twin-twin transfusion syndrome（TTTs）（16.67 %）,3 cases intrauterine infection（16.67%）,and unknown causes in 5 cases（27.78%）.Cesarean section was the delivery mode in 15 cas-es,and 3 cases vaginal delivery.Little effect was on mother＇s coagulation in twin pregnancy after single intrauterine fetal death（P〉0.05）.Conclusions： There were differences in the maternal and fetal outcome between DCDA and MCDA.A lot of impact on the mother and survival fetus occurred after single intrauterine fetal death in twin pregnancy.Expectant therapy was an effective choice for twin pregnan-cy complicated by single intrauterine death before delivery because the small gestational age and immature fetus.