双胎妊娠-胎宫内死亡20例临床分析

目的探讨双胎妊娠-胎宫内死亡的原因、临床处理及预后。方法回顾性分析1994年3月至2008年2月北京大学第三医院双胎妊娠-胎宫内死亡的病例共20例。结果双胎-胎宫内死亡的发生率为3．2％，其中双卵双胎17例，单卵双胎3例。28w前发现-胎宫内死亡者6例，平均期待治疗95．8天，平均分娩孕周为34．4w（32^＋4-39w）；28w后发现-胎宫内死亡者14例，平均期待治疗10．1天，平均分娩孕周为34．6w（29^＋4-39^＋2w）；仅2例新生儿发生轻度窒息。无一例孕妇发生凝血功能障碍。追踪新生儿6月至14年，1例新生儿因合并隐性脊柱裂及早产原因早期死亡，1例患儿3岁时发生运动障碍性脑瘫（分娩孕周为29^＋6w），4例失访，其余均健康存活。结论双胎妊娠-胎宫内死亡后可采取期待治疗，严密监测存活胎儿宫内状况，尽量延长孕周，可提高存活胎儿的生存质量。

A clinical analysis of 20 cases of twin pregnancy with one fetal intrauterine death

Objective:To study the cause,clinical treatment,and prognosis of twin pregnancy with one fetal intrauterine death.Methods:20 cases of twin pregnancy with one fetal intrauterine death from March 1994 to February 2008 in Peking University Third Hospital were studied.Results:The rate of twin pregnancy with one fetal intrauterine death is 3.2%.Of the 20 cases,there were 17 dizygotic twins(85%)and 3 monozygotic twins(15%).6 patients were found one fetal death within 28 weeks of pregnancy;their pregnancy were terminated after averagely 95.8 days of expectant treatment;average termination time were 34.4 weeks.14 patients were found intrauterine death after 28 weeks of pregnancy;their pregnancy were terminated after averagely 10.1 days of expectant treatment;average termination time were 34.6 weeks.Only 2 premature delivery cases had mild asphyxia,while others didn't.Of the 20 cases,no coagulation disturbance occurred.Follow-up the prognosis of 20 cases,4 cases were missing;of the other 16 cases,1 newborn died from pre-mature labor combined with spina bifida occulta,1 case suffered from cerebral palsy at the age of 3,while the others are normal.Conclusion:On condition that the intrauterine surviving fetal and maternal coagulation function are watched and maternal complications and accompanying diseases are dealt with,expectant treatment is an effective way of treating twin pregnancy with one fetal intrauterine death.