CAJ | 학술논문

目的：探讨单绒毛膜（monochorionic，MC）双胎妊娠一胎胎死宫内后处理。方法通过回顾性分析本院2013年收治的2例单绒毛膜双胎妊娠一胎胎死宫内（single intrauterinefetal death，sIUFD）后发生急性胎-胎输血的病例，结合文献复习，探讨 MC 双胎妊娠如何预防 sIUFD 发生，以及发生 sIUFD的处理。结果2013年本院收治 MC 双胎妊娠发生 sIUFD 的2例，均发生胎-胎输血，其中1例孕13＋5周超声明确为单绒毛膜双胎妊娠，孕23周超声提示双胎儿大小不一致，孕35＋5周发现一胎胎死宫内，积极剖宫产终止妊娠，存活新生儿轻度窒息、贫血，现满一周岁，发育正常。另外1例未系统产检，孕8周超声提示单绒毛膜双胎妊娠，孕31＋6周发现一胎胎死宫内，另一胎儿胸腹腔积液，观察一周后存活儿多体腔积液且头皮水肿，放弃存活儿行引产术，引产前查存活儿明显贫血，引产后大孩呈失血貌，小孩呈淤血貌。结论减少双胎妊娠 sIUFD 的发生，要做到早期识别绒毛膜性，加强孕期监护，早期发现高危因素，及时干预，处理上要综合孕周、存活儿情况、孕妇情况等采取个体化。
목적：탐토단융모막（monochorionic，MC）쌍태임신일태태사궁내후처리。방법통과회고성분석본원2013년수치적2례단융모막쌍태임신일태태사궁내（single intrauterinefetal death，sIUFD）후발생급성태-태수혈적병례，결합문헌복습，탐토 MC 쌍태임신여하예방 sIUFD 발생，이급발생 sIUFD적처리。결과2013년본원수치 MC 쌍태임신발생 sIUFD 적2례，균발생태-태수혈，기중1례잉13＋5주초성명학위단융모막쌍태임신，잉23주초성제시쌍태인대소불일치，잉35＋5주발현일태태사궁내，적겁부궁산종지임신，존활신생인경도질식、빈혈，현만일주세，발육정상。령외1례미계통산검，잉8주초성제시단융모막쌍태임신，잉31＋6주발현일태태사궁내，령일태인흉복강적액，관찰일주후존활인다체강적액차두피수종，방기존활인행인산술，인산전사존활인명현빈혈，인산후대해정실혈모，소해정어혈모。결론감소쌍태임신 sIUFD 적발생，요주도조기식별융모막성，가강잉기감호，조기발현고위인소，급시간예，처리상요종합잉주、존활인정황、잉부정황등채취개체화。
Objective To discuss the treatment of a monochorionic twin pregnancy after single intrauter-ine fetal death (sIUFD).Method Medical records were reviewed and analyzed of two monochorionic twin pregnancies that complicated acute twin-twin transfusion after sIUFD in the past 2013.Literature was re-viewed to investigate how to prevent single intrauterine fetal death,and what treatment we should take af-ter sIUFD.Results Two MC twin pregnancies complicated sIUFD were admitted in our hospital in 2013 and twin-twin transfusion befell to both of them.By fetal ultrasonography,one was diagnosed monochori-onicity at 13 +5 gestation weeks and size disparity between the twin was found at 23 gestation weeks.At 35 +5 gestation weeks,sIUFD was diagnosed and uterine-incision delivery was taken to save the survival fe-tal.The survival neonate,who experienced mild asphyxia and anaemia,is one year old now and is health-y.The other one was diagnosed monochorionicity at 8 gestation weeks,and didn’t take perinatal care reg-ularly.At 31 +6 gestation weeks sIUFD was founded and the survival fetal was diagnosed hydrothorax and seroperitoneum by fetal ultrasonography.After a week,the survival fetal was founded more serious than before and was abandoned by induced delivery.Before induced delivery,the analysis showed the survival fetal was obvious anaemia.And after induced delivery,the big neonate was anaemic and the small neonate was congestive.Conclusions To reduce the the incidence of sIUFD in twin pregnancies,we should recognize the chorionicity as early as we can,enhance gestational period care,so as to discover the high risk factor earlier and to take measure in time.A management plan should be individualised,and should take the factors such as the gestation weeks,the suvival fetal’s health condition and the gravida’s diseases into consideration.