双胎之一胎死宫内34例的妊娠结局分析  

A analysis of 34 cases of twin pregnancies with single intrauterine fetal death in pregnancy outcomes

作　　者：林颖[1] 王蕴慧[2] 

机构地区：[1]南方医科大学附属深圳市妇幼保健院产科,广东省518028 [2]中山大学孙逸仙纪念医院妇产科,广州510120

出　　处：《中华临床医师杂志（电子版）》2015年第10期90-94,共5页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的探讨双胎妊娠一胎胎死宫内的病因、临床处理及影响妊娠结局的相关因素。方法回顾性分析2003年1月至2012年12月在中山大学孙逸仙纪念医院住院分娩的双胎妊娠一胎胎死宫内病例共34例。结果双胎之一胎死宫内的发生率为6.8%,34例中双绒毛膜双胎18例,单绒毛膜双胎9例（其中单羊膜腔双胎3例）,绒毛膜性不详7例。一胎胎死宫内发生于早期妊娠8例,中期妊娠13例,晚期妊娠13例。共有24例进行期待治疗,期待治疗时间中位数为62.5（41-209）d,分娩孕周中位数为32.6（16.0-38.7）周。妊娠早期发生一胎胎死宫内组,在存活儿活产数、分娩孕周及出生体重方面均高于妊娠中、晚期组。双绒毛膜双胎发生一胎胎死宫内组,在存活儿活产数、分娩孕周及出生体重方面均高于单绒毛膜双胎组及绒毛膜性不详组。结论绒毛膜性、死胎发生的孕周及终止妊娠的孕周是影响妊娠结局的重要因素。加强母儿监测,进行适当的期待治疗,是改善妊娠结局的有效方式。Objective To study the etiology, clinical management and the related factors affecting the pregnancy outcomes of twin pregnancies with single intrauterine fetal death （sIUFD）. Methods Retrospective analysis was done in 34 cases of twin pregnancies with sIUFD from April 2003 to October 2012 in Sun Yat-sen Memorial Hospital of Sun Yat-sen University. Results The incidence of twin pregnancies with sIUFD was 6.75% in the hospital. There were 18 cases of dichorionic twins, 9 cases of monochorionic twins （including monoamiotic twins 3 cases） and 7 cases of unknown chorionic twins respectively. In 8 cases, twin pregnancies with slUFD was found in the first trimester of gestation; in 13 cases, it was found in the second trimester of gestation; and in 13 cases it was found in the third trimester of gestation. A total of 24 patients with expectant treatment, treatment of the median time of 62.5 （41-209） days, median gestational age at delivery 32.6 （16.0-38.7） weeks. The number of live births, birth gestational age and birth weight for twin pregnancies with slUFD occurred during first trimester of gestation, were higher than in late pregnancy group. In the same way, twin pregnancies with slUFD occurred for dichorionic twins, were higher than monochorionic twins or unknown chorionic twins group. Conclusion Chodonicity, stillbirth weeks of gestation and delivery gcstational age are the significant factors affecting the pregnancy outcomes. To strengthen the monitoring of maternal complications and the survival fetal, expectant treatment is an effective way of improving the pregnancy outcomes of twin pregnancies with sIUFD.

关 键 词：双胎妊娠 一胎胎死宫内 绒毛膜性 

分 类 号：R714.5[医药卫生—妇产科学]