82例双胎之一宫内死亡原因及临床处理探讨

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...

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

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.