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目的 探讨双胎妊娠中一个胎儿宫内死亡的原因及对存活胎儿的影响和处理。方法 回顾性分析1989～ 1998年我院收治的 2 7例双胎之一胎儿宫内死亡的原因及处理。结果 8例孕周大于 34周双胎者在确诊一个胎儿死亡后 ,活胎即行剖宫产。 5例从确诊一个胎儿死亡至存活胎儿分娩时间平均相隔 8周。双胎之一胎儿死亡主要原因 :脐带因素 5例、胎儿畸形 3例、帆状胎盘 4例、原因不明 15例。结论 孕早中期双胎之一胎儿死亡后存活的胎儿预后良好 ;胎龄较大的胎儿死亡后 ,可增加存活胎儿的围产期病死率和患病率 ,尤其是单卵双胎 ;应加强对存活胎儿的监护以决定分娩时机和方式 ;对孕 34周以后发现的双胎之一胎儿宫内死亡者应考虑终止妊娠。
Objective To investigate the causes of intrauterine death in twin pregnancies and their effects on surviving fetuses. Methods Retrospective analysis of the causes and treatment of intrauterine fetal death in 27 fetuses born in our hospital from 1989 to 1998. Results 8 cases of gestational age greater than 34 weeks of twins were diagnosed with a fetal death, the live birth of the cesarean section. 5 cases from the diagnosis of a fetal death to survival of the average fetus childbirth interval of 8 weeks. One of the twins The main causes of fetal death: 5 cases of umbilical cord factors, 3 cases of fetal malformations, 4 cases of placenta of sail, unexplained 15 cases. Conclusions Fetal fetuses surviving in the first trimester of pregnancy have a good prognosis. The fetus with larger gestational age may increase the perinatal mortality and morbidity of surviving fetuses, especially the monozygotic twins. It should be strengthened The custody of the surviving fetus determines the timing and manner of delivery; termination of pregnancy should be considered for intrauterine fetal death, one of the twins found after 34 weeks of gestation.