妇产与遗传（电子版）
婦產與遺傳（電子版）
부산여유전（전자판）
Obstetrics-Gynecology and Genetics(Electronic Edition)
2014年
2期
29-35
,共7页
黄莺莺%张燕菲%张园%王志坚
黃鶯鶯%張燕菲%張園%王誌堅
황앵앵%장연비%장완%왕지견
双胎%死胎%妊娠结局
雙胎%死胎%妊娠結跼
쌍태%사태%임신결국
twins%fetal death%pregnancy outcome
目的：探讨双胎之一胎儿宫内死亡的妊娠结局及母儿预后。方法回顾性分析2002年6月至2012年12月在南方医科大学南方医院住院分娩的13例双胎之一胎儿宫内死亡的母儿病历资料，并对其进行随访调查。结果1.孕妇情况：首次发现双胎之一胎儿死亡的时间在13+1~36+5周，平均29周。分娩孕周在30~39+1周，平均35周。2.胎儿结局：存活胎儿出生体重在1130~2890 g，平均体重2220 g。2例存活儿B超发现异常，其中1例为透明隔增宽，1例为胎儿生长受限。1例新生儿重度窒息，1例新生儿轻度窒息，11例未发生新生儿窒息。死胎原因有脐带扭转1例、染色体异常1例、脐带绕颈1例、绒毛膜炎1例、胎盘早剥1例；8例死胎原因不详。3.产妇及存活儿随访情况：2例产妇分娩前患类风湿性关节炎及慢性高血压，分娩后仍存在；1例产妇患妊娠期糖尿病，产后复查血糖仍有异常。1例产妇发生产后出血，1例发生产后慢性DIC，11例产妇未发生晚期产后出血。存活儿现年龄2个月~10岁，1例7岁患儿身体发育较同龄儿童滞后，1例查体发现凝血功能轻度异常。结论双胎之一胎儿宫内死亡是早产及剖宫产率增高的重要原因，孕晚期死胎对产妇凝血功能影响较大，顺产和剖宫产对母儿的结局无明显差别，存活儿的预后与孕龄、出生体重及有无窒息关系更为密切。
目的：探討雙胎之一胎兒宮內死亡的妊娠結跼及母兒預後。方法迴顧性分析2002年6月至2012年12月在南方醫科大學南方醫院住院分娩的13例雙胎之一胎兒宮內死亡的母兒病歷資料，併對其進行隨訪調查。結果1.孕婦情況：首次髮現雙胎之一胎兒死亡的時間在13+1~36+5週，平均29週。分娩孕週在30~39+1週，平均35週。2.胎兒結跼：存活胎兒齣生體重在1130~2890 g，平均體重2220 g。2例存活兒B超髮現異常，其中1例為透明隔增寬，1例為胎兒生長受限。1例新生兒重度窒息，1例新生兒輕度窒息，11例未髮生新生兒窒息。死胎原因有臍帶扭轉1例、染色體異常1例、臍帶繞頸1例、絨毛膜炎1例、胎盤早剝1例；8例死胎原因不詳。3.產婦及存活兒隨訪情況：2例產婦分娩前患類風濕性關節炎及慢性高血壓，分娩後仍存在；1例產婦患妊娠期糖尿病，產後複查血糖仍有異常。1例產婦髮生產後齣血，1例髮生產後慢性DIC，11例產婦未髮生晚期產後齣血。存活兒現年齡2箇月~10歲，1例7歲患兒身體髮育較同齡兒童滯後，1例查體髮現凝血功能輕度異常。結論雙胎之一胎兒宮內死亡是早產及剖宮產率增高的重要原因，孕晚期死胎對產婦凝血功能影響較大，順產和剖宮產對母兒的結跼無明顯差彆，存活兒的預後與孕齡、齣生體重及有無窒息關繫更為密切。
목적：탐토쌍태지일태인궁내사망적임신결국급모인예후。방법회고성분석2002년6월지2012년12월재남방의과대학남방의원주원분면적13례쌍태지일태인궁내사망적모인병력자료，병대기진행수방조사。결과1.잉부정황：수차발현쌍태지일태인사망적시간재13+1~36+5주，평균29주。분면잉주재30~39+1주，평균35주。2.태인결국：존활태인출생체중재1130~2890 g，평균체중2220 g。2례존활인B초발현이상，기중1례위투명격증관，1례위태인생장수한。1례신생인중도질식，1례신생인경도질식，11례미발생신생인질식。사태원인유제대뉴전1례、염색체이상1례、제대요경1례、융모막염1례、태반조박1례；8례사태원인불상。3.산부급존활인수방정황：2례산부분면전환류풍습성관절염급만성고혈압，분면후잉존재；1례산부환임신기당뇨병，산후복사혈당잉유이상。1례산부발생산후출혈，1례발생산후만성DIC，11례산부미발생만기산후출혈。존활인현년령2개월~10세，1례7세환인신체발육교동령인동체후，1례사체발현응혈공능경도이상。결론쌍태지일태인궁내사망시조산급부궁산솔증고적중요원인，잉만기사태대산부응혈공능영향교대，순산화부궁산대모인적결국무명현차별，존활인적예후여잉령、출생체중급유무질식관계경위밀절。
Objective To investigate the perinatal outcome, maternal and fetal prognosis of single intrauterine death in twin pregnancy. Method 13 cases of single intrauterine death in twin pregnancies from June 2002 to December 2012 in Nanfang Hospital, Southern Medical University were analyzed retrospectively, then carried a follow-up investigation. Results (1) Time of fetal death was detected from 13 w+1 d to 36 w+5 d gestational weeks, average is 29 w gestational weeks. Birth weight of living fetus is 1130g~2890 g,average is 2220 g.(2) In 13 neonates, 1 case was severe asphyxia in newborn, 1 case was mild asphyxia neonatorum. The reasons of fetal death included torsion of umbilical cord, chromosome disorder, unchal cord, chorioamnionitis and placental abruption. 8 cases couldn't be found definite death cause. 2 cases showed ultrasound abnormal, one was fetal septum pellucidum, the other was FGR. (3) 2 puerperants suffered rheumatoid arthritis and chronic hypertension, the disease still present after delivery;1 puerpera suffered gestational diabetes mellitus her blood glucose was still abnormal after delivery. In 13 puerperants, 1 case happened postpartum hemorrhage, 1 case happened post partum chronicity DIC. Survivors’age are from 2 months to 10 years old. There is a 7 years old boy, his physical development is hysteresis compare with the same age children. 1 surviror was detected mild blood coagulation dysfunction. Conclusions Single intrauterine death in twin pregnancy raises up premature labor rate and uterine-incision delivery rate. It has greater influence on puerperants’s blood clotting function when fetal death happened in late pregnancy. Pregnancy outcome has no significant difference between normal labor and uterine-incision delivery. Survivors’prognosis is more related with gestational age, birth weight and asphyxia.
