孕中晚期双胎之一胎死宫内存活儿预后分析

Prognostic of the co-twin who survives after single intrauterine fetal demise

目的:分析双胎之一胎死宫内(sIUFD)后存活儿的预后。方法:回顾分析2017年1月至2019年11月在郑州大学第三附属医院分娩的sIUFD病例58例,包括sIUFD发生孕周、胎死原因、不同孕周及不同绒毛膜性存活儿的新生儿结局及脑损伤情况,并随访其神经发育情况。结果:58例孕中晚期发生sIUFD的病例中单绒毛膜双羊膜囊双胎(MCDA)27例,双绒毛膜双羊膜囊双胎(DCDA)31例。死亡原因中脐带、胎盘异常占25.9%(15/58),胎儿发育异常占5.2%(3/58);存活儿的早产率为70.7%(41/58),其中最小孕周28+1周。与DCDA双胎组比较,MCDA双胎组分娩胎龄、出生体重、Apgar评分均较低。与孕中期比较,孕晚期发生sIUFD的早产率、MCDA双胎数及急诊剖宫产率更高,新生儿出生体重、Apgar评分更低。新生儿出生后头颅超声脑异常9例,其中新生儿脑损伤3例(5.2%,3/58),分别为2例脑软化,1例脑室内出血Ⅲ级。存活儿目前的存活率为91.4%(53/58),随访时间平均28个月,3例婴幼儿智能发育量表(CDCC)监测可疑。结论:绒毛膜性、死胎发生孕周、终止妊娠的孕周是影响妊娠结局的主要因素,需加强产前、产后神经影像学检查及远期标准化随访。

Objective:To analyze the prognosis of surviving twin pregnancies with single intrauterine fetal demise(sIUFD).Methods:Retrospectively analyzed the twin pregnancy cases admitted in the Third Affiliated Hospital of Zhengzhou University between January 2017 and November 2019.We recorded the gestational age at occurrence of single fetal demise,cause of fetal death,neonatal outcomes,cerebral injury of different gestational age and different chorionic and followed up neonatal growth.Results:The 58 twin pregnancies with sIUFD cases included 31 cases of dichorionic twins,27 cases of monochorionic twins.Among the death-caused factors,umbilical cord and placenta abnormality accounted for 25.9%(15/58),fetal malformation accounted for 5.2%(3/58).The premature birth rate of the surviving fetus was 70.7%(41/58),of which the minimum gestational week was 28+1 week.The birth gestational age,birth weight and Apgar score in MC twins were significantly lower than those in DC twins.The number of MC twins,premature birth and emergency caesarean section with sIUFD occurred during third-trimester were higher than those during mid-trimester.Among the live births,9 cases of fetal cranial ultrasound were abnormal,including 3 cases of neonatal cerebral injury(5.2%,3/58),which 2 got periventricular leukomalacia and 1 got intraventricular hemorrhageⅢ.The current survival rate of surviving fetus was 91.4%(53/58),and the average follow-up time was 28 months.Three cases of CDCC monitoring were suspicious.Conclusion:Chorionic、stillbirth weeks of gestation and delivery gestational age are the most important factors affecting the perinatal outcomes.We need to strengthen prenatal and postnatal neuroimaging examination and long-term standardized follow-up.