双胎妊娠第二胎延迟分娩的临床分析

Clinical analysis of delayed interval delivery of the twin

目的:探讨双胎妊娠第二胎延迟分娩的临床情况、处理及妊娠结局。方法:回顾分析2016年6月至2018年12月在华中科技大学同济医学院附属同济医院行双胎妊娠第二胎延迟分娩的8例患者的临床资料。结果:8例双胎妊娠延迟分娩患者中第一胎分娩平均孕周22.29周(16+4~29+5周),平均分娩体重462.5g(150~1400g),5例死胎,2例放弃,1例新生儿存活;第二胎分娩平均孕周23.98周(17+3~30+6周),出生平均体重661.25g(180~1600g),3例死胎,2例放弃,1例新生儿科死亡,2例存活预后良好。分娩间隔时间3~50天,平均11.88天。第一胎分娩后,均予抗感染、保胎、促胎肺成熟等治疗,2例行宫颈环扎术。孕妇中2例术后监测中出现感染给予抗炎治疗,2例因胎盘植入产后出血。结论:双胎妊娠第二胎延迟分娩处理得当可提高第二胎新生儿的存活率及预后,但需把握好指征,严密监测感染及胎儿胎盘情况,早期发现并发症,适时终止妊娠。

Objective:To investigate the clinical feature,treatment and outcome of delayed interval delivery of the second twin. Methods:Retrospective analysis of clinical features of 8 cases of delayed interval delivery of the twin occurred in Tongji Hospital of Huazhong University of Science and Technology during Jun.2016~Dec.2018. Results:For the 8 cases of delayed interval delivery,the gestational age of delivery of the first twin varied from 16 +4 weeks to 29 +5 weeks and the average gestation age was 22.29 weeks,birth weight varied from 150g to 1400g and the average weight was 462.5g.The pregnancy outcomes were 5 dead fetus,2 infants abandon and 1 infants survived.The gestational age of delivery of the second twin varied from 17 +3 weeks to 30 +6 weeks and the average was 23.98 weeks,birth weight varied from 180g to 1600 g and the average weight was 661.25g,and 3 dead fetus,1 infant abandon,1 infant dead and 2 infants survived.The interval of the first and second twin delivery varied from 3 days to 50 days and the average was 11.88 days.After delivery of the first twin,antibiotics,inhibition of uterine contraction and promotion of fetus lung maturity were adopted.2 patients had cervical cerclage.2 patients infected and 2 patients placenta implantation and postpartum hemorrhage. Conclusions:Delayed interval delivery of the twin could increase the survival rate of the second twin newborn,we need to grasp the guidelines,closely monitor,early detect its complication,timely termination of pregnancy.