82例双胎之一宫内死亡原因及临床处理探讨

Reason and clinical procedure approach of one twin’s intrauterine death

关键词:  双胎  宫内死亡  期待治疗

Key words:  twins  intrauterine death  expectant

摘要:

［目的］探讨双胎之一宫内死亡后最佳终止妊娠时机。［方法］收集浙江大学附属妇产科医院2000年1月～2010年7月共82例双胎之一宫内死亡的病例，根据终止妊娠时机在＜孕30周、30～34周及≥34周分为A、B、C三组。回顾性分析双胎之一宫内死亡后孕妇与存活胎儿情况及不同时机终止妊娠的新生儿近期预后结局。［结果］82例孕妇中，1例发现亚急性DIC，余均未出现凝血功能异常。存活胎儿的新生儿死亡率，存在母体合并症者为25.0%（4/16），双胎输血综合征者为7.7%（1/13），原因不明者为5.6%（2/36），前者与后两者比较差异均有显著性意义，P<0.05。不同时间终止妊娠的新生儿死亡率，A组为50.0% （4/8），B组为6.5% （2/31），C组为2.3% （1/43），A、B与A、C组间比较差异有显著性意义（P<0.05），B、C两组间比较差异无显著性意义。剖宫产组及平产组的新生儿死亡率差异无显著性意义（P>0.05）。［结论］双胎之一宫内死亡对母体影响较小，对存活胎儿的影响程度与病因相关。如母体及存活胎儿情况良好，以目前的新生儿抢救能力，尽量延长孕周对改善双胎一死一活新生儿近期预后有积极影响。分娩方式不影响新生儿近期结局。

Abstract:

［Objective］To evaluate the best time point for the termination of pregnancy after one twin's intrauterine death while the other one stays alive.［Methods］From January 2000 to July 2010,a total of 82 cases of one twin's intrauterine death were collected from Women’s Hospital School of Medicine,Zhejiang University.These cases were divided into the group A,B,C while the time of the termination of pregnancy was <30 weeks,between 30 to 34 weeks or ≥34 weeks respectively.The situations of gravida and the survival twin after one twin's intrauterine death,and the prognosis of neonatal outcome in the near future were analyzed according to different timing of the termination of pregnancy period retrospectively.［Results］One gravida in 82 cases developed into subacute DIC,others had not appeared coagulopathy.Neonatal mortality was 25.0% (4 in 16) in patients with maternal's complication,7.7% (1 in 13) in twin-to-twin transfusion syndrome,and 5.6% (2 in 36) in unknown origin.There were significant differences between the first one and the others.As to the neonatal mortality, Group A was 50.0% (4/8),Group B was 6.5% (2/31),and Group C was 2.3% (1/43).There were significant differences between group A and B,group A and C (P<0.05),while no significant difference between group B and C.Neonatal mortality was not significant different between C-S and normal delivery group.［Conclusions］Intrauterine death of one twin has little impact on the gravida,and its influence on the survival fetus is cause-related.If the maternal's and survival fetal's situations are both well,as to the current rescuing capacity of the newborn,prolonging the gestational age as long as possible has a positive impact on improving the near prognosis of the living twin infant.Mode of delivery does not affect neonatal near outcome.