双胎之一胎儿宫内死亡原因及处理19例临床分析

Clinical Analysis of 19 Intrauterine Death of One of Twins

目的 :探讨双胎妊娠中一个胎儿宫内死亡的原因及处理。方法 :回顾性分析 1995～ 2 0 0 0年我院收治的 19例双胎之一胎儿宫内死亡的原因及妊娠结局。结果 :5例 <2 8周者 4例放弃胎儿作引产术 ,1例孕 2 6周及 7例 2 8～ 34周从确诊一个胎儿死亡后继续保胎到存活儿分娩 ,平均延长 6周 ,5例 >34周者确诊后随即行剖宫产 ,此 13例新生儿均存活。另 2例足月但未及时处理 ,活胎死亡。死亡主要原因 :脐带因素 2例、帆状胎盘 3例 ,胎儿畸形 2例 ,原因不明 12例。妊娠并发症比例较高占 6 3.16 %。结论 :孕周 <2 8周者一般作终止妊娠处理 ;妊娠 2 8～ 34周存活的胎儿继续妊娠到孕 34周预后良好 ;对孕

Objectives:To explore the causes and management of death of one of twins.Methods: The cause and pregnancy outcome of 19 intrauterine death of one of twins from 1995 to 2000 were retrospectively analyzed.Results: four out of 5 cases less than 28 weeks with one death of twins was induced voluntarily.one cases with 26 week and 7 cases between 28 and 34 weeks were found one of twins dead.The average time between the confirmed death and the other living born was 6 weeks.C-section was carried out immediately in 5 cases after confirming the death of one of the twins with gestational age older than 34 weeks.These 13 fetuses were alive.But there were 2 cases full-term fetuses dead,due to the delayed treatment.The main causes of the death of one fetus in twin pregnancy were cord elements(2 cases),velamentous insertion(3 cases),fetal deformity(2 cases)and unknown etiology(12cases).The rate of complicated by pregnancy was 63.16%.Conclusion :Less than 28 weeks with one death of twins generally is terminated pregnancy.Between 28 and 34 weeks,the prognosis is good the pregnancy terminated after 34 weeks.Termination of pregnancy should be considered when one of twins is found intrauterine death after 34 gestation weeks.