摘要
目的探讨双胎妊娠中一胎死亡的原因及对母亲和存活胎儿的影响及其临床处理方法 。方法对1998年1月至2008年12月分娩的双胎妊娠之一胎死亡的16例产妇临床资料进行回顾性分析。结果双胎之一为宫内死胎的发生率占双胎的4.41%,其中单绒毛膜双胎11例(68.75%),双绒毛膜双胎5例(31.25%)。胎儿死因:脐带因素6例(37.50%),胎盘因素4例(25.00%),妊娠并发症3例(18.75%),双胎输血综合征1例(6.25%),胎儿畸形1例(6.25%),不明原因1例(6.25%)。期待治疗最长达63d,单绒毛膜双胎平均期待治疗时间为3.36周,平均分娩周孕为35.5周,双绒毛膜双胎平均期待治疗时间为9.5周,平均分娩孕周为35.7周。剖宫产13例,阴道分娩3例。双胎之一胎死亡后对母体的凝血功能影响不大。结论脐带、胎盘异常是胎死于宫内的重要原因;双胎之一胎死于宫内对母体及存活儿有一定影响.但孕周小,胎儿尚不成熟,严密监测存活胎儿宫内情况,积极处理产科并发症,行期待治疗可延长孕龄至足月,可提高围生儿存活率。单绒毛膜双胎较双绒毛膜双胎期待治疗时间有明显差别。
Objection To explore the cause of fetal death of one twin pregnancy and the influence to the survival one as well as the clinical management. Methods A retrospective analysis was given to sixteen cases which were fetal death of one twin pregnancy in our hospital from January 1998 to December 2008. Results Among all the twin pregnancy, fetal deaths of one were account for 4.38 %, including 11 monochorionic twin pregnancys and 5 dichorionic ones, account for 68.75 % and 31.25 % respectively. Reason of the fetal death： umbilical cord factors 37.5% （6 cases） ; placental factors 25 % （4 cases） ; gravid complications 18.75%（3 ca ses） ; twin-to-twin transfusion syndrome 6.25% （1 case） ; fetal malformation 6.25% （ 1 case） ; unexplained death 6.25% （ 1 case）. The longest expectant treatment time lasted for 63 days. The average expectant treatment time of monochorionic twin pregnancy was 3.36 weeks, and the mean gestation week on labor was 35.5 weeks. While the average expectant treatment time of dichorionic ones was 9.5 weeks, and the mean gestation week on labor was 35.7 weeks. 13 cases had Caesarean birth, 3 cases had natural labor. Fetal death of one twin pregnancy had little influence on coagulative ruction. Conclusion Umbilical cord and placental abnormality was an important cause leading to fetal death. Twin pregnancy with a stillborn fetus had some influence on the maternal body and the survival fetus. However, because of the small gestational age and immaturity of fetus, the expectant treatment with close monitor and treatment of complication would prolong the gestational age to the natural term to improve the perinatal infant survival rate. The expectant treatment time between monoehorionic and dichorionic twin pregnancy differs significantly.
出处
《重庆医学》
CAS
CSCD
北大核心
2010年第15期2049-2050,共2页
Chongqing medicine
关键词
双胎妊娠
一胎死亡
临床处理
期待疗法
twin pregnancy
death of one twin pregnancy
clinical management
expectant treatment
