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目的:探讨双胎妊娠中一胎宫内死亡的原因、对母亲和存活胎儿的影响及临床处理方法。方法:对2001年1月至2011年10月分娩的双胎妊娠之一胎宫内死亡的18例产妇临床资料进行回顾性分析。结果:双胎妊娠一胎宫内死胎的发生率占双胎的1.08%,其中单绒毛膜双羊膜囊双胎(monochorionic-diamniotic twin,MCDA)11例(61.11%),双绒毛膜双羊膜囊双胎(dichorionic-diamniotic twin,DCDA)7例(38.89%)。胎儿死因:胎盘脐带因素3例(16.67%),胎儿畸形1例(5.56%),妊娠并发症3例(16.67%),双胎输血综合征(twin-twin transfusion syndrome,TTTs)3例(16.67%),宫内感染3例(16.67%),不明原因5例(27.78%)。另一胎选择剖宫产者13例,阴道分娩3例。双胎一胎死亡后对母体的凝血功能影响不大(P>0.05)。结论:单绒毛膜双胎较双绒毛膜双胎母儿结局存在差别;双胎一胎宫内死亡对母体及存活儿有一定影响。对于孕周小,胎儿尚不成熟的病例,可严密监测存活胎儿宫内情况,行期待治疗延长孕龄至足月再分娩。
Objective: To investigate the causes of intrauterine death in twin pregnancies and their effects on mothers and surviving fetuses and their clinical management. METHODS: A retrospective analysis of 18 pregnant women with intrauterine fetal death who were born within one of the twin pregnancies from January 2001 to October 2011 was performed. Results: The incidence of stillbirth in unmarried fetus with twins was 1.08% of the twins, among which 11 (61.11%) were monochorionic-diamniotic twin (MCDA), double amniotic double amniotic sac Twice (dichorionic-diamniotic twin, DCDA) in 7 cases (38.89%). The cause of fetal death was placental umbilical cord in 3 cases (16.67%), fetal malformation in 1 case (5.56%), pregnancy complications in 3 cases (16.67%) and twin-twin transfusion syndrome (TTTs) in 3 cases %), Intrauterine infection in 3 cases (16.67%), unexplained 5 cases (27.78%). Another fetus selected cesarean in 13 cases, vaginal delivery in 3 cases. Twins have no effect on the coagulation function of the maternal after the death of one fetus (P> 0.05). Conclusion: The single chorionic twins have the same result as the double chorionic maternal twins. The intrauterine death of twins and fetuses has a certain impact on maternal and survivors. For small gestational weeks, the fetus is not yet mature cases, can closely monitor the survival of intrauterine fetal conditions, the line is expected to extend treatment of gestational age to full delivery again.