双胎之一胎死宫内的绒毛膜性及发生孕周对妊娠结局的影响  

Influence of chorionicity and gestational age of single intrauterine fetal death on pregnancy outcome

作　　者：李根霞[1] 楚书慧 李娇 程春花[1] 刘月华[1] 冯帆[2] 董理 LI Gen-xia;CHU Shu-hui;LI Jiao;CHENG Chun-hua;LIU Yue-hua;FENG Fan;DONG Li(Obstetrics Department,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;The Ultrasound Department,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第三附属医院产科,郑州450052 [2]郑州大学第三附属医院超声科,郑州450052

出　　处：《医药论坛杂志》2022年第13期16-19,共4页Journal of Medical Forum

基　　金：河南省医学科技攻关计划项目(2018020196)。

摘　　要：目的探讨绒毛膜性及双胎之一胎死宫内(sIUFD)发生孕周对妊娠结局的影响。方法选择2017年1月至2021年6月在郑州大学第三附属医院分娩的83例sIUFD病例。按照绒毛膜性分为单绒毛膜双胎(MCT)组(n=43)及双绒毛膜双胎(DCT)组(n=40),回顾性分析孕妇一般资料、sIUFD发生孕周、绒毛膜性、妊娠及新生儿结局。结果与DCT组相比,MCT组的另一胎死亡率(P<0.001)及新生儿输血治疗率(P=0.045)显著增高。MCT组中:≥28周发生sIUFD者的早产率(P=0.031)、新生儿贫血(P=0.018)及新生儿输血治疗率(P=0.011)高于<28周发生sIUFD者;DCT组中:≥28周发生sIUFD者的新生儿贫血发生率显著高于<28周发生sIUFD者(P=0.042)。进一步分析胎儿顺序发现,与存活儿先露的双胎相比,死胎先露双胎的早产率更高(P=0.007)。存活儿先露病例的平均分娩孕周延长4.08周。结论绒毛膜性、sIUFD孕周及胎儿顺序均影响孕妇及围产儿结局。对于单绒毛膜性双胎sIUFD,应加强母儿监测,及时干预并适时终止妊娠以改善另一胎预后。Objective To investigate the influence of chorionicity and gestational age of single intrauterine fetal death(sIUFD)on pregnancy outcome.Methods A total of 83 cases of sIUFD who delivered in the Third Affiliated Hospital of Zhengzhou University from January 2017 to June 2021 were selected.According to chorionicity,they were divided into the group of monochorionic twins(MCT)(n=43)and the group of dichorionic twins(DCT)(n=40).The general data of pregnant women,gestational age of sIUFD,chorionicity,pregnancy and neonatal outcomes were retrospectively analyzed.Results Compared with DCT group,MCT group had a greater risk of co-twin intrauterine fetal death(P<0.001)and incidence of neonatal transfusion therapy(P=0.045).In MCT group,the incidence of preterm delivery(P=0.031),neonatal anemia(P=0.018)and neonatal transfusion therapy(P=0.011)in patients with sIUFD≥28 weeks were higher than those with sIUFD<28 weeks.In DCT group,the incidence of neonatal anemia in patients with sIUFD≥28 weeks were higher than those with sIUFD<28 weeks(P=0.042).Further analysis of fetal order showed that the rate of premature delivery of the dead twin presentation was higher than that of survival twin presentation(P=0.007),and the average gestational age of patients with survival twin presentation was extended by 4.08 weeks.Conclusion Chorionicity,gestational age of sIUFD and fetal order are all affected maternal and perinatal outcomes.For monochorionic twins,maternal and infant monitoring should be strengthened,and timely intervention and termination of pregnancy so as to improve the prognosis of another fetus.

关 键 词：双胎妊娠 宫内死亡 绒毛膜性 孕周 胎儿顺序 

分 类 号：R714[医药卫生—妇产科学]