双胎妊娠一胎胎死宫内90例妊娠结局分析  

Characteristics of Single Intrauterine Fetal Death in Twin Pregnancy:A Retrospective Analysis of 90 cases

作　　者：李馨 耿力[1] LI Xin;GENG Li(Department of Obstetric,The First Affiliated Hospital of Kunming Medical University,Kunming Yunnan 650032,China)

机构地区：[1]昆明医科大学第一附属医院产科,云南昆明650032

出　　处：《实用妇产科杂志》2021年第11期865-869,共5页Journal of Practical Obstetrics and Gynecology

摘　　要：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:①sIUFD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。Objective:To explore the clinical characteristics and pregnancy outcomes of single intrauterine fetal death(sIUFD)in twin pregnancy.Methods:A total of 90 cases with sIUFD who were managed in The First Affiliated Hospital of Kunming Medical University from September 2016 to January 2021 were retrospectively analyzed,the clinical characteristics and pregnancy outcomes of different chorionic monochorionic(MC)twins(31 cases)and dichorionic(DC)twins(59 cases)were estimated.Results:①Pregnancy loss of surviving co-twins occurred in 14 cases(15.6%),including 6 of abortion and 8 of induced labor(5 cases of intrauterine death and 3 cases of fetal abnormality).The incidence of fetal death and premature delivery in MC twins was higher than that in DC twins(P<0.05).There was no significant differences in the incidence of live birth,neonatal asphyxia,NICU transfer,neonatal brain injury and death between the two groups(P>0.05).②7 cases of pregnancy terminated within 24 hours after the diagnosis of sIUFD,of which 2 cases surviving co-twins with TTTS died.Compared with DC twins,the intervalbetween sIUFD and delivery was shorter in MC twins(P<0.05),and the gestational age of delivery was earlier(P<0.05).③There were no significant differences in neonatal asphyxia rate,NICU conversion rate and neonatal mortality between vaginal delivery and cesarean section(P>0.05).Conclusions:The risk of adverse pregnancy outcomes of surviving co-twin in MC twins with sIUFD is increased,which should be strengthened monitoring.sIUFD is not an indication of pregnancy termination by cesarean section,vaginal delivery does not increase the incidence of adverse prognosis of newborns.

关 键 词：双胎妊娠 胎死宫内 绒毛膜性 分娩孕周 

分 类 号：R714.43[医药卫生—妇产科学]