双胎妊娠一胎死亡后期待治疗14例分析

目的:探讨双胎妊娠孕中晚期一胎死亡后期待治疗的临床效果。方法:回顾性研究分析1994年1月至2004年4月同济医院双胎妊娠一胎死亡的病例共14例。结果:期待治疗时间最长为61天,最短为3小时,平均保胎时间为12天,分娩平均孕周为32周。无一例出现明显凝血功能障碍。先兆子痫和胎膜早破发生率最高(35.7%)。胎儿畸型是胎死宫内的重要原因。结论:双胎妊娠一胎死亡后可采取期待治疗,在严密监测存活胎儿宫内安危,积极处理母体合并症或并发症的条件下,尽量延长存活胎儿在宫内生长的时间,提高存活胎儿的生存质量。     

双胎妊娠1胎胎死宫内13例临床病例分析

目的探讨双胎妊娠1胎胎死宫内存活胎儿临床预后及处理方法。方法回顾性分析2000年1月至2009年6月于本院分娩的13例孕中晚期双胎妊娠1胎胎死宫内病例。结果双胎妊娠1胎胎死宫内的发生率为2.83%,13例双胎妊娠1胎胎死宫内的患者,7例为单绒毛膜双胎,6例为双绒毛膜双胎。共8名患者接受了期待治疗。1胎胎死宫内确诊的平均孕周为31+4周。双胎妊娠1胎胎死宫内较早期早产(34周)的发生率单绒毛膜双胎者高于双绒毛膜双胎者,分别为57.1%(4/7),33.3%(2/6);新生儿死亡率分别为33.3%(2/6),0(0/5)。期待治疗的患者中,1例出现了弥漫性血管内凝血,并因此终止妊娠。5名接受经颅多普勒超声检查的新生儿,3名存在颅内病变。结论孕中晚期双胎妊娠1胎胎死宫内者,单绒毛膜双胎妊娠者预后较差。对胎死宫内发生时间较早者,可在密切监测下行期待治疗以降低早产的发生率,改善预后。     

双胎妊娠一胎胎死宫内90例妊娠结局分析

目的:探讨双胎妊娠一胎胎死宫内(sIUFD)的临床特点及妊娠结局。方法:回顾性分析2016年9月至2021年1月昆明医科大学第一附属医院收治的90例sIUFD的临床资料,其中单绒毛膜(MC)双胎(31例),双绒毛膜(DC)双胎(59例)。分析不同绒毛膜性sIUFD存活胎儿的预后,sIUFD存活胎儿终止妊娠的时间、分娩方式等。结果:(1)sIUFD孕妇存活胎儿妊娠丢失14例(15.6%),其中流产6例,引产8例(胎死宫内5例,胎儿异常3例)。MC双胎存活胎儿胎死宫内、早产发生率高于DC双胎(P<0.05);两组间存活胎儿活产、新生儿窒息、转NICU、新生儿脑损伤、新生儿死亡的发生率差异均无统计学意义(P>0.05)。(2)发现sIUFD后24小时内终止妊娠7例,其中2例双胎输血综合征(TTTS)存活胎死亡。MC双胎与DC双胎相比,发生sIUFD距分娩间隔时间较短(P<0.05),分娩孕周较早(P<0.05)。(3)新生儿窒息率、转NICU率、新生儿死亡率在阴道分娩与剖宫产中比较,差异无统计学意义(P>0.05)。结论:MC双胎发生sIUFD存活胎儿发生胎死宫内及早产的不良妊娠结局风险明显增加,应加强监测。sIUFD不是剖宫产术终止妊娠的指征,阴道分娩并不增加新生儿不良预后的发生率。     

双胎中—胎儿死亡的监护

双胎中一胎儿宫内死亡时,过去多主张及时终止妊娠以防严重并发症。近来一些研究表明,在适当管理下多数存活儿能继续妊娠至足月或接近足月,降低了双胎妊娠围产儿病死率。 1发生率 1.1妊娠12周后的发生率:孕12周后双胎中一胎儿宫内死亡的发生率为0.5％～7％,其中,单卵双胎,尤其是单绒毛膜双胎(monochorionic twin)的发生率较双卵双胎或双绒毛膜双胎(dichorionic twin)高2.5倍。 1.2妊娠12周前的发生率:超声研究提示,此期双胎一胎儿宫内死亡相当多,发生率为20％～70％。     

双胎之一胎死宫内原因监测与处理

当前 ,辅助生殖技术广泛开展 ,多胎妊娠的上升使双胎妊娠中一胎死亡的报道逐渐增多。随着围生医学的发展 ,胎儿监测手段的进步 ,使原有的期待疗法增添了积极因素 ,期待疗法与及时终止妊娠是处理双胎之一胎死宫内过程中十分重要的两种方案 ,处理恰当可降低围生儿死亡率。1　发生率该发生率各家报道不一 ,山东省立医院王佩贞 1994年报道为 8 9% ,中山医科大学附属医院张颖报道为4 98% [1] 。我院 1989～ 1998年十年间双胎 3 0 1例 ,其中11例双胎之一胎死宫内 ,发生率为 3 65 %。国外资料中 ,美国Ｅｎｂｏｍ[2 ] 1985年报道为 5 0 % ,日本今…     

双胎妊娠一胎宫内死亡34例临床分析

目的:探讨双胎妊娠一胎宫内死亡的原因、临床处理及预后。方法:回顾性分析2005年1月至2009年12月,我院双胎妊娠一胎宫内死亡34例患者的临床资料。结果:双胎妊娠一胎宫内死亡占我院双胎妊娠的5.2%,34例中单羊膜囊双胎3例,单绒毛膜双胎23例,双绒毛膜双胎8例;及时终止妊娠23例(单羊膜囊双胎均及时终止妊娠),期待治疗11例,平均期待时间单绒毛膜双胎为4.7±5.6周,双绒毛膜双胎为8.6±1.2周;单绒毛膜双胎发现死胎时的孕周、分娩孕周及存活儿的出生体重均小于双绒毛膜双胎。除引产外的30例存活儿发生围生儿死亡6例,随访24例存活新生儿中,2例失访,22例随访中发生脑瘫(四肢瘫,语言障碍)3例,存在其他脑损害(语言或运动发育延迟)4例,余健康存活。结论:单绒毛膜双胎更易发生双胎妊娠一胎宫内死亡,绒毛膜性质和孕周是影响围生儿结局和远期预后的重要因素,存活儿无胎儿窘迫,孕妇无严重妊娠并发症及合并症情况下,期待治疗是一种有效的处理方式。     

双胎妊娠1胎死亡的处理

问 :双胎妊娠一胎死亡 ,该如何处理 ?答 :妊娠 12周以后 ,双胎妊娠出现 1胎死亡的发生率国内报道为 3.6 %～ 8.9% ,国外报道在 0 .5 %～ 6 .8% ,常见于单绒毛膜双胎 ,单绒毛膜双胎一胎死亡发生率 3倍于双绒毛膜双胎 ,双胎妊娠一胎死亡的原因有 :1脐带病变 (脐带打结、缠绕、脐带扭转、脐带帆状附着 ) ;2胎儿畸形 ;3双胎输血综合征(TTTS) ;4胎盘因素 ;5原因不明。处理原则是在保证母亲安全前提下 ,力争存活胎儿的预后较好。双胎妊娠一胎死亡的处理与胎儿死亡的时间和双胎类型有关。孕早期双胎妊娠发现一胎死亡而另一胎正常 ,死亡的孕囊逐渐…     

双绒毛膜双羊膜囊双胎妊娠一胎胎母输血综合征一例

胎母输血(fetomaternal hemorrhage,FMH)综合征是指因某种原因胎儿血液通过绒毛间隙进入母体血液循环,引起胎儿贫血或母体溶血性输血反应的一组症候群。FMH缺乏特异性临床表现,易漏诊,围产儿死亡率高。可通过超声测量胎儿大脑中动脉血流收缩期峰值速率及Kleihauer-Betke试验评估胎儿贫血程度及失血量,处理方法包括宫内输血及终止妊娠。胎母输血量>20 ml/kg与胎儿/新生儿的并发症发病率或死亡率有关。FMH在双胎妊娠中的发病罕见报道。本例患者为双绒毛膜双羊膜囊双胎妊娠,其中一胎出现FMH表现,胎死宫内,另一胎儿在严密监测下期待至足月分娩,结局良好。     

双胎妊娠

双胎妊娠的围产期病死率比单胎高达6倍以上,而且由先天性缺陷、早产、子宫胎盘功能不全和产伤所引致的患病率也相当高。几乎50％的双胎妊娠会发生早产,大多数胎儿的体重在2500g以下,而第二个胎儿的体重通常更轻些。有关双胎的流行情况和并发症的发生,可由单卵双胎或双卵双胎而有所不同。由单个受精卵分裂而形成的为单卵双胎,所以单卵双胎的胎儿具有相同的遗传物质。单卵双胎的随机发生率约为3‰～5‰,其发     

双胎妊娠的产前筛查和产前诊断

据统计，双胎妊娠约占总妊娠的1％～1．2％左右。双胎分为双卵双胎和单卵双胎，其中单卵双胎约占30％。双卵双胎为双绒毛膜双胎，其胎盘间没有血管吻合；单卵双胎分为双绒毛膜双羊膜、单绒毛膜双羊膜、单绒毛膜单羊膜、联体双胎，其胎盘间血管吻合发生率达85％以上，约15％的单绒毛膜双胎将发展为双胎输血综合征（twin-twin transfusion syndrome，TTTS）。由于双胎的自然流产率、早产率及围产儿死亡率都明显高于单胎，而绒毛膜特性又是影响双胎结局的最主要因素，单绒毛膜双胎的围产期死亡率是双绒毛膜双胎的3～5倍，所以双胎绒毛膜性质的诊断至关重要，也是讨论双胎产前诊断的前提。     

The epidemiology of pregnancy complications and outcome in a Norwegian twin population.

OBJECTIVE: To measure the contribution of genetic factors to selected pregnancy complications, including miscarriage, twinning, hypertension-toxemia, and nausea-vomiting. METHODS: Information on 22,241 pregnancies of 8675 female twins or spouses of male twins was obtained by questionnaire from members of the population-based Norwegian Twin Panel. Comparisons of observed tetrachoric correlations were used to assess the importance of genetic influences on the variables examined. RESULTS: Pregnancy history information was provided by both members of 830 monozygotic and 902 dizygotic female twin pairs and by the spouses of both members of 459 monozygotic and 464 dizygotic male twin pairs. The incidence of twin pregnancy in general, and of opposite-sexed twins in particular, found among dizygotic twin women was nearly twice that observed for any other group. Monozygotic female twin pairs were more concordant than dizygotic female twin pairs for the occurrence of miscarriage, nausea or vomiting during pregnancy, and hypertension or overt toxemia. A similar pattern of twin similarity was observed for the use of certain medications during pregnancy including vitamins, aspirin, and nausea medication. CONCLUSIONS: Maternal genetic factors make an important contribution to a predisposition for dizygotic twinning, contribute to the risk of miscarriage, and appear to determine, in part, whether a woman experiences nausea-vomiting or hypertension-toxemia during pregnancy. In addition, health-seeking behaviors of women during pregnancy, as reflected by the use of several classes of medication, appear to be influenced somewhat by genetic factors.     

Effect of twin pregnancy chorionic properties on maternal and fetal outcomes

Objective

This study aimed to determine the effect of twin pregnancy chorionic properties on pregnancy complications and fetal outcomes.

发育不同一性双胎妊娠的并发症临床分析

目的 探讨发育不同一性双胎妊娠的并发症特点及双胎发育不同一性发生的相关因素。方法 以双胎胎儿体重差＞20％为发育不同一性双胎妊娠诊断标准,回顾性分析96例发育不同一性双胎(观察组)和349例发育一致双胎(对照组)的临床资料,比较两组在妊娠并发症、合并症、分娩情况和围产儿预后等方面的差异。结果 (1)观察组晚期流产、羊水过多、双胎输血综合征和胎盘早剥的发生率分别为13．5％(13／96)、22．9％(22／96)、9．4％(9／96)和5．2％(5／96),明显高于对照组的4．3％(15／349)、10．0％(35／349)、1．4％(5／349)和1．1％(4／349),两组比较,差异有统计学意义(P＜0．05)。(2)观察组围产儿死亡和胎儿畸形的发生率分别为22．9％(44／192)和5．2％(10／192),明显高于对照组的4．4％(31／698)和1．3％(9／698),两组比较,差异有统计学意义(P＜0．01)。(3)观察组胎儿体重轻者较体重重者的围产儿死亡率高,分别为30．2％(29／96)和15．6％(15／96),两组比较,差异有统计学意义(P＜0．05);体重差分别为≤20％、20％～30％和≥30％时,围产儿死亡率分别为4．4％、11．0％和41．9％;胎儿畸形发生率分别为1．3％、5．1％和5．4％,3者间分别比较,差异有统计学意义(P＜ 0．05)。结论发育不同一性双胎妊娠主要的并发症为晚期流产、羊水过多、双胎输血综合征、胎盘早剥、围产儿死亡和胎儿畸形。双胎中体重轻者围产儿死亡率高,且随体重差别增大围产儿死亡和胎儿畸形发生率升高。     

双胎之一胎儿宫内死亡27例原因及处理

目的　探讨双胎妊娠中一个胎儿宫内死亡的原因及对存活胎儿的影响和处理。方法　回顾性分析1989～ 1998年我院收治的 2 7例双胎之一胎儿宫内死亡的原因及处理。结果　 8例孕周大于 34周双胎者在确诊一个胎儿死亡后 ,活胎即行剖宫产。 5例从确诊一个胎儿死亡至存活胎儿分娩时间平均相隔 8周。双胎之一胎儿死亡主要原因 :脐带因素 5例、胎儿畸形 3例、帆状胎盘 4例、原因不明 15例。结论　孕早中期双胎之一胎儿死亡后存活的胎儿预后良好 ;胎龄较大的胎儿死亡后 ,可增加存活胎儿的围产期病死率和患病率 ,尤其是单卵双胎 ;应加强对存活胎儿的监护以决定分娩时机和方式 ;对孕 34周以后发现的双胎之一胎儿宫内死亡者应考虑终止妊娠。     

双胎之一胎死宫内的诊治

随着促排卵技术和辅助生殖技术的发展，多胎妊娠发生率逐年增多。与单胎妊娠相比，多胎妊娠围产儿病死率更高。双胎之一胎死宫内属于双胎妊娠的严重并发症，一胎死亡后会对存活胎儿有潜在、长期的影响，可引起存活胎儿死亡、神经系统损伤、早产及相关后遗症等，因此，孕期应加强母儿监护。及时诊断和处理是改善围产儿结局的关键。     

Fetal biometric parameters, twin type and birth weight difference. A longitudinal study

OBJECTIVE: To examine the relationship between twin type, divided by zygosity, chorionicity, and birth weight difference [more or less than 15% intertwin weight difference at delivery] on fetal biometric measurements, including biparietal diameter, transverse abdominal diameter, head and abdominal circumferences (AC) and head and abdominal areas, femur length (FL), transverse cerebellar diameter, cerebellar circumference and cerebellar area at 18, 23, 28 and 32 weeks of gestational age. STUDY DESIGN: A prospective and longitudinal study was done on 75 twin pairs that did not present the twin-twin transfusion syndrome (150 fetuses) divided into birth weight difference group I (<15%) and group II (>/=15%). The twin pairs were divided into three groups: dizygotic, monochorionic, and dichorionic-monozygotic. In each group the differences in various ultrasound indices were evaluated in reference to discordant growth or concordant growth. RESULTS: In our sample, there were no monozygotic twin pairs with dichorionic placentation with a birth weight difference of more than 15%. Significant associations of group and gestational age were found in dizygotic and monochorionic twins. Intrapair differences were significantly higher in group II (>/=15%) than in group I (<15%) for all fetal parameters studied except for AC, abdominal area and all cerebellar parameters. The value of these discrepancies increased according to gestational age except for FL. Significant interactions between group and zygosity type indicated that intrapair FL differences were more associated with group in monochorionic twins, whereas intrapair transverse cerebellar diameter differences were more associated with group in dizygotic twins. CONCLUSION: Our data show that most fetal biometric parameters are associated with birth weight discordancy. Abdominal area could be a relevant marker for twins with obstetric complications. Note that this is the first research that has studied a twin sample divided by both twin type and birth weight group.     

Birthweight in liveborn twins: the influence of the umbilical cord insertion and fusion of placentas

Objective To assess the relation of umbilical cord insertion and fusion of placentas with birthweight in monozygotic monochorionic, monozygotic dichorionic, and dizygotic twins.
Design A prospective population study.
Population 4529 liveborn twin pairs whose birthweight was recorded, placentas were examined, and site of umbilical cord insertion was determined after delivery.
Results Infants with a peripheral cord insertion weighed 150g less (   P <0.001  ) than infants with a central cord insertion. Dizygotic infants had a significantly (   P <0.001  ) higher incidence of central cord insertion (82%) than monozygotic dichorionic (65%) and monozygotic monochorionic (53%) infants. Monozygotic dichorionic infants with fused placentas and a peripheral cord insertion weighed on average 300g less (   P <0.01  ) than infants with separate placentas and a central cord insertion. In dizygotic infants, fusion of the placentas did not affect birthweight.
Conclusions Umbilical cord insertion is associated with birthweight in all types of twins. Fusion of the placentas only affects the birthweight of monozygotic dichorionic, not that of dizygotic infants. This might be due to the greater proximity of implantation of monozygotic dichorionic twins. Dizygotic twins weighed more than monozygotic twins only when placentas were fused and cord insertion was peripheral. Hence, the difference between the mean birthweights of dizygotic, monozygotic dichorionic, and monozygotic monochorionic infants may originate from the least favourable antenatal situation, namely fused placentas with a peripheral cord insertion, which occurs most frequently in monozygotic twins.     

Does chorionicity or zygosity predict adverse perinatal outcomes in twins?

OBJECTIVE: The purpose of this study was to evaluate chorionicity and zygosity as risk factors for adverse perinatal outcomes in twins. STUDY DESIGN: A population-based, retrospective cohort study was conducted of all twin deliveries in Nova Scotia, Canada, from 1988 to 1997. Chorionicity was established by histologic examination. Zygosity was determined by chorionicity, sex, and infant blood group. Three groups were established: monochorionic/monozygotic twins, dichorionic/dizygotic twins, and dichorionic/majority monozygotic twins. RESULTS: Outcomes from 1008 twin pregnancies were analyzed. Monochorionic/monozygotic twins had lower mean birth weights compared with dichorionic/dizygotic twins. Rates of perinatal mortality of at least 1 twin were significantly higher among monochorionic/monozygotic twins relative to dichorionic/dizygotic twins (relative risk, 2.5; 95% CI, 1.1-2.5). Dichorionic/majority monozygotic twins had similar perinatal outcomes compared with dichorionic/dizygotic twins. CONCLUSION: Monochorionicity increases the risk of adverse perinatal outcome, whereas the effect of zygosity is less clear. Because chorionicity can be determined by prenatal ultrasound scanning, this information should be considered in the prenatal care of twin pregnancies.     

Perinatal outcome and management of single fetal death in twin pregnancy: a case series and review

OBJECTIVE: To determine neonatal outcome of single fetal death in twin pregnancy. METHODS: Retrospective study was performed on 30 cases of single fetal death in twin pregnancy during the period from August 1971 to December 1997 at Kitasato university hospital. RESULTS: The incidence of single fetal death in twin pregnancy was 6.2% among total number of 481 twins. Prognosis of surviving infants was satisfactory except in one case, with malformation in 10 cases of dichorionic twins (total 242 sets). In contrast, neonatal death occurred in 6 cases of 20 monochorionic twins (total 239 sets), 4 of which were among 7 cases of twin-to-twin transfusion syndrome (TTTS). Cerebral palsy occurred in 2 infants of monochorionic twins. One case was diagnosed as periventricular leukomalacia (PVL) within one week after birth, and this was the case of delivery 1 day after one twin fetal death. CONCLUSION: Single fetal death itself occurs more often in monochorionic twins. There seems to be a benign outcome for the surviving dichorionic twins. On the other hand, there may be a grave outcome, though infrequent, for monochorionic twins when concomitant TTTS has existed. It is very important to identify the chorionicity by ultrasound examination in early pregnancy.     

Discordance of fetal genotype or phenotype in monozygotic twins: a report of 2 cases

BACKGROUND: Discordance of fetal genotype or phenotype in a monozygotic twin pregnancy is rare. CASE: In case 1, a 28-year-old woman at 15 weeks' gestation was found to have a dichorionic twin pregnancy with 1 fetus affected with hydrop fetalis. The result of chromosomal study showed that the structurally normal fetus was 46,XY and that the hydropic fetus was 45,X. One week after selective termination of the hydropic fetus at 19 weeks' gestation, the cotwin died in utero. In case 2, a 30-year-old woman at 20 weeks' gestation, was found to have a monochorionic twin pregnancy with 1 fetus presenting with omphalocele. The result of chromosomal study showed that both fetuses were 46,XX. The fetus with omphalocele died in utero at 29 weeks' gestation, and the normal cotwin was delivered later due to fetal distress. Analysis by short tandem repeat markers in both cases indicated that they were monozygotic twins. CONCLUSION: These cases emphasize the importance of zygosity/chorionicity identification in twin pregnancy even though discordance of fetal genotype or phenotype was found. In monozygotic monochorionic twins, the normal cotwin is at risk for an adverse fetal outcome after 1 spontaneous intrauterine fetal death or selective termination. In monozygotic dichorionic twins, the risk of intrauterine fetal demise of the cotwin after selective termination still exists.