13例双胎之一胎儿宫内死亡病例的母儿预后分析  

Maternal and fetal prognosis analyses in 13 cases of single intrauterine death in twin pregnancies

作　　者：黄莺莺[1] 张燕菲 张园[1] 王志坚[1] 

机构地区：[1]南方医科大学南方医院妇产科,广州510515 [2]花都区妇幼保健院产科,广州510515

出　　处：《妇产与遗传（电子版）》2014年第2期29-35,共7页Obstetrics-Gynecology and Genetics (Electronic Edition)

摘　　要：目的探讨双胎之一胎儿宫内死亡的妊娠结局及母儿预后。方法回顾性分析2002年6月至2012年12月在南方医科大学南方医院住院分娩的13例双胎之一胎儿宫内死亡的母儿病历资料,并对其进行随访调查。结果 1.孕妇情况:首次发现双胎之一胎儿死亡的时间在13+1~36+5周,平均29周。分娩孕周在30~39+1周,平均35周。2.胎儿结局:存活胎儿出生体重在1 130~2 890 g,平均体重2 220 g。2例存活儿B超发现异常,其中1例为透明隔增宽,1例为胎儿生长受限。1例新生儿重度窒息,1例新生儿轻度窒息,11例未发生新生儿窒息。死胎原因有脐带扭转1例、染色体异常1例、脐带绕颈1例、绒毛膜炎1例、胎盘早剥1例;8例死胎原因不详。3.产妇及存活儿随访情况:2例产妇分娩前患类风湿性关节炎及慢性高血压,分娩后仍存在;1例产妇患妊娠期糖尿病,产后复查血糖仍有异常。1例产妇发生产后出血,1例发生产后慢性DIC,11例产妇未发生晚期产后出血。存活儿现年龄2个月~10岁,1例7岁患儿身体发育较同龄儿童滞后,1例查体发现凝血功能轻度异常。结论双胎之一胎儿宫内死亡是早产及剖宫产率增高的重要原因,孕晚期死胎对产妇凝血功能影响较大,顺产和剖宫产对母儿的结局无明显差别,存活儿的预后与孕龄、出生体重及有无窒息关系更为密切。Objective To investigate the perinatal outcome, maternal and fetal prognosis of singleintrauterine death in twin pregnancy. Method 13 cases of single intrauterine death in twin pregnancies fromJune 2002 to December 2012 in Nanfang Hospital, Southern Medical University were analyzed retrospectively,then carried a follow-up investigation. Results(1) Time of fetal death was detected from 13 w+1d to 36 w+5d gestational weeks, average is 29 w gestational weeks. Birth weight of living fetus is 1130g^2890 g,average is2220 g。(2) In 13 neonates, 1 case was severe asphyxia in newborn, 1 case was mild asphyxia neonatorum. Thereasons of fetal death included torsion of umbilical cord, chromosome disorder, unchal cord, chorioamnionitisand placental abruption. 8 cases couldn't be found definite death cause. 2 cases showed ultrasound abnormal,one was fetal septum pellucidum, the other was FGR.(3) 2 puerperants suffered rheumatoid arthritis andchronic hypertension, the disease still present after delivery; 1 puerpera suffered gestational diabetes mellitusher blood glucose was still abnormal after delivery. In 13 puerperants, 1 case happened postpartumhemorrhage, 1 case happened post partum chronicity DIC. Survivors' age are from 2 months to 10 years old.There is a 7 years old boy, his physical development is hysteresis compare with the same age children. 1surviror was detected mild blood coagulation dysfunction. Conclusions Single intrauterine death in twinpregnancy raises up premature labor rate and uterine-incision delivery rate. It has greater influence onpuerperants' s blood clotting function when fetal death happened in late pregnancy. Pregnancy outcome has nosignificant difference between normal labor and uterine-incision delivery. Survivors' prognosis is more relatedwith gestational age, birth weight and asphyxia.

关 键 词：双胎 死胎 妊娠结局 

分 类 号：R714.2[医药卫生—妇产科学]