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目的 探讨双胎妊娠中一胎死于宫内对母亲和存活胎儿的影响。方法 对 1989年 1月至 2 0 0 0年 11月在我院分娩的双胎之一为宫内死胎的 19位母亲的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 7.6 6 % (19/2 48) ,占同期分娩总数的 0 .776‰ (19/2 44 80 ) ,其中单绒毛膜双胎 12例 ,占 6 3.12 % (12 /19) ,双绒毛膜双胎 5例 ,占 2 6 .32 % (5 /19) ,2例不详。该 19例中剖宫产 14例 ,占 73.6 8% ,明显高于自然产 (2 6 .32 % )。胎儿死因 :脐带因素占 5 7.89% (11/19) ,双胎输血综合症占 15 .79% (3/19) ,重度妊高症占 10 .5 3%(2 /19) ,胎儿畸形占 10 .5 3% (2 /19) ,不明原因占 5 .2 6 % (1/19)。本组双胎早产率为 2 6 .32 % (5 /19) ,明显低于双活胎 (5 6 .37% )。其中 18位母亲的凝血功能正常 ,1位重度妊高症并发溶血、肝酶升高、血小板减少 (即 HEL L P综合症 )患者出现明显的出血倾向。结论 脐带异常改变是胎死宫内的重要原因 ;死胎对母亲及活胎的近期危害不大 ,可以在密切监护下继续妊娠 ,对活胎的远期危害有待进一步研究
Objective To investigate the impact of one child died of intrauterine life on mothers and surviving fetuses in twin pregnancy. Methods The clinical data of 19 mothers who died of intrauterine fetal death from January 1989 to November 2000 were retrospectively analyzed. Results One of the twins was intrauterine fetal death accounted for 7.66% (19/2 48) of the twins, accounting for 0.776 ‰ (19/2 44 80) of the total number of deliveries in the same period, in which the single chorionic twins 12 Cases, accounting for 6 3.12% (12/19), double chorionic twins in 5 cases, accounting for 26.32% (5/19), 2 cases unknown. The 19 cases of cesarean section in 14 cases, accounting for 73.6%, significantly higher than natural production (26.32%). Fetal causes of death: 5 7.89% (11/19) of umbilical cord factors, 15.79% (3/19) of twin transfusion syndrome, 10.53% (2/19) of severe pregnancy-induced hypertension, 10 .5 3% (2/19), unexplained causes accounted for 5.26% (1/19). Premature birth rate of this group of twins was 26.32% (5/19), significantly lower than live births (56.37%). Among them, 18 mothers had normal blood clotting function, and one patient with severe pregnancy-induced hypertension complicated with hemolysis, elevated liver enzymes, and thrombocytopenia (HEL L P syndrome) developed obvious bleeding tendency. Conclusion The abnormal changes of umbilical cord is an important cause of fetal death. Stillbirth has little harm to mothers and live fetuses in the near future. Pregnancy can be continued under close supervision. The long-term harm to live fetus needs further study