双胎妊娠之一胎宫内死亡13例临床分析

目的探讨双胎妊娠之一胎宫内死亡的原因和处理及其对存活儿的影响.方法对我院1996～2005年收治的13例双胎妊娠之一胎宫内死亡的病例进行回顾性分析.结果双胎妊娠之一胎宫内死亡的发生率为5.53%.其主要原因:脐带因素4例,双胎输血综合征3例及纸样儿2例,胎儿畸形3例,胎盘因素2例,原因不明2例.2例孕早期双胎妊娠一胎死宫内孕妇,足月顺产死亡胎儿呈纸样儿.9例从确诊一个胎儿死亡至存活胎儿分娩时间8小时至10周不等.孕28周和孕(33 2)周2例,双胎之一胎死宫内孕妇行期待疗法,分别于孕(34 2)周因胎儿窘迫行剖宫产及(40 2)周顺产.结论孕早中期双胎儿之一胎儿死亡后存活的胎儿预后良好;对孕28～34周的病例在严密监测存活胎儿下行期待疗法,可适当延长存活儿的胎龄;而对孕龄≥34周应考虑终止妊娠.

The clinical Analysis of 13 intrauterine death of one of twins

Objective To explore the cases, management of death of one of twins and its effects on theother survivor. Methods 13 intrauterine death of one of Twins from 1996 to 2005 were analysedretrospecfively. Results The incidence of intrauterine death of one of Twins is 5.53% .The main caseswere cord elements (4 cases), TTTS (3 cases) and Papyraceous fetus (2 cases), fetal deformity (3cases), placenta elements (2 cases) and unknown etiology (2 cases).there are two women of pregnancywhose one fetus died in twin pregnancy at the first gestational periods , have bearing smoothly a fullmonths papyraceous fetus. In 9 cases, the average time interval between the confirmed death and theother living born was about 8 hour and 10weeks. Lf given the expectant remedy to the pregnant womenof 28 gestation weeks ax well as (33 2) gestation weeks whose one fetus died in twin pregnancy, onepregnant woman of (34 2) gestation weeks has the cesarean section because of fetal distress,the otherwoman of (42 2) gestation weeks has spontaneous labor at last Conclusion Prognosis of the live fetuswas pretty well when the other died at the first or second trimester. If we take the expectant remedyto the pregnant women who has the symptom of disease for 28 to 34 weeks and monitor the fetus for thesurvivor strictly, the gestational age of the survivor fetus will prolong suitably.Termination ofpregnancy must be considered older than 34 gestation weeks .