双胎妊娠一胎宫内死亡34例临床分析

摘要

目的:探讨双胎妊娠一胎宫内死亡的因为、临床处理及预后.方法:回顾性分析2005年1月至2009年12月,我院双胎妊娠一胎宫内死亡34例患者的临床资料.结果:双胎妊娠一胎宫内死亡占我院双胎妊娠的5.2%,34例中单羊膜囊双胎3例,单绒毛膜双胎23例,双绒毛膜双胎8例;及时终止妊娠23例(单羊膜囊双胎均及时终止妊娠),期待治疗11例,平均期待时间单绒毛膜双胎为4.7±5.6周,双绒毛膜双胎为8.6±1.2周;单绒毛膜双胎发现死胎时的孕周、分娩孕周及存活儿的出生体重均小于双绒毛膜双胎.除引产外的30例存活儿发生围生儿死亡6例,随访24例存活新生儿中,2例失访,22例随访中发生脑瘫(四肢瘫,语言障碍)3例,存在其他脑损害(语言或运动发育延迟)4例,余健康存活.结论:单绒毛膜双胎更易发生双胎妊娠一胎宫内死亡,绒毛膜性质和孕周是影响围生儿结局和远期预后的重要因素,存活儿无胎儿窘迫,孕妇无严重妊娠并发症及合并症情况下,期待治疗是一种有效的处理方式.%Objective: To study the causes, clinical management and prognosis of twin pregnancies complicated by single intrauterine death (slUD). Methods: Retrospective analysis was done in 34 cases of twin pregnancies complicated by slUD from January 2005 to December 2009 in West China Second University Hospital of Sichuan University. Results: The incidence rate of twin pregnancies complicated by slUD was 5. 2％. There were 3 monoamnionic twins, 23 monochorionic twins and 8 dichorionic twin pregnancies complicated by slUD respectively. Termination of the pregnancy timely in 23 cases including monoamnionic twins was done. The average expectant time of monochorionic and dichorionic twins were 4. 7 ± 5. 6 weeks and 8. 6 ± 1.2 weeks respectively in 11 cases receiving expectant treatment. The average gestational weeks of fetal death and delivery, birth weight of survivals for monochorionic twins were less than dichorionic twins.There were 6 perinatal deaths in 30 surviving twins except 4 cases for induced labor. 2 neonates were dropped out in 24 survival neonates. In 22 survival neonates with follow-up, there were 3 cases with cerebral palsy(quadriplegia, dysphasia), 4 cases with other cerebral impairment (delayed growth of speaking and movement) ,while the other 15 cases were normal. Conclusions: Single intrauterine death is more common in monochorionic twin pregnancies. Chorionicity and gestational week are the most important factors affecting the perinatal outcome and long-term prognosis. Expectant treatment is an effective choice for twin pregnancy complicated by slUD without severe maternal complications or fetal distress.