双胎之一胎儿宫内死亡51例临床分析

Clinical Analysis of 51 Cases of Single Intrauterine Fetal Demise in Twin Pregnancy

目的:探讨双胎之一胎儿宫内死亡(sIUFD)的原因、临床处理及母婴预后。方法:回顾性分析2009～2012年在南方医科大学附属深圳妇幼保健院住院分娩的51例sIUFD孕妇(sI-UFD组)的临床资料,同时随机抽取同期51例双胎均存活者作为对照组进行病例对照分析。结果:①sIUFD组胎儿畸形、胎儿生长受限(FGR)、双胎输血综合征(TTTS)、脐带扭转、单脐动脉发生率、辅助生殖技术(ART)受孕率均明显高于对照组(P<0.05)。两组妊娠期高血压疾病、妊娠期糖尿病和妊娠期肝内胆汁淤积症发生率相比,差异无统计学意义(P>0.05)。②sIUFD组发现一胎儿死亡平均孕周为28.7±6.4周,期待孕周中位数为3.1周,四分位数间距为13.1周。单绒毛膜双胎终止妊娠平均孕周为34.6±2.2周,双绒毛膜双胎为35.9±1.9周。③两组新生儿窒息发生率比较,差异无统计学意义(P>0.05)。两组均无围生儿死亡。sIUFD组随访47例,存活儿生长发育均正常,失访4例。结论:胎儿畸形、FGR、TTTS、脐带扭转和单脐动脉是sIUFD的主要原因,母体合并症及并发症与sIUFD的关系不明显,ART对sIUFD的影响有待进一步研究。单绒毛膜双胎期待治疗至妊娠34周、双绒毛膜双胎期待治疗至37周后,以改善新生儿预后。

Objective：To investigate the cause,clinical management and maternal-neonatal outcomes of single intrauterine fetal demise （slUFD） in twin pregnancy. Methods：The clinical data of 51 cases of slUFD in twin pregnancy（slUFD group ） from 2009 to 2012 were retrospectively analyzed. 51 cases of normal twin pregnancy in the same period were included as controls. Results：①The incidences of fetal anomalies,fetal growth restriction （ FG R）, twin-twin transfusion syndrome （ TTTS）, torsion cord, single umbilical artery, assisted reproductive techniques（ART） in the slUFD group were significantly higher than those in the control group（ P 〈0.05）. There were no statistically significant differences in hypertensive disorders pregnancy,gesrational diabetes mellitus,intrahepatic cholestasis of pregnancy between the two groups （ P 〉 0.05）. ②The average gestational age of single intrauterine fetal demise （slUFD） in twin pregnancy was 28.7± 6.4 weeks,the medium of expectant time was 3. 1 weeks,and the quartile intervals was 13. 1 weeks. The termination of monochorionic twin pregnancy gestational age was 34. 6 ±2.2 weeks on average and that of dichorionic twin was 35.9 ± 1.9 weeks. ③There was no statistically significant difference in neonatal asphyxia between the two groups（ P〉0. 05）. There was no perinatal mortality in both groups. In the follow-up visit of the slUFD group,47 survivors were normal,4 cases were lost of follow-up. Conclusions： Fetal anomalies, FGR, TTTS,torsion cord and single umbilical artery are the critical reasons for the slUFD in twin pregnancy. There is no obvious relationship between maternal complications and slUFD in twin pregnancy. The connection between ART and slUFD in twin pregnancy needs to carry on deeper research, slUFD in monochorionic twin pregnancy should be expected to 34 weeks and slUFD in dichorionic twin pregnancy should be expected to 37 weeks to improve neonatal outcomes.