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目的探讨双胎妊娠1胎胎死宫内存活胎儿临床预后及处理方法。方法回顾性分析2000年1月至2009年6月于本院分娩的13例孕中晚期双胎妊娠1胎胎死宫内病例。结果双胎妊娠1胎胎死宫内的发生率为2.83%,13例双胎妊娠1胎胎死宫内的患者,7例为单绒毛膜双胎,6例为双绒毛膜双胎。共8名患者接受了期待治疗。1胎胎死宫内确诊的平均孕周为31+4周。双胎妊娠1胎胎死宫内较早期早产(<34周)的发生率单绒毛膜双胎者高于双绒毛膜双胎者,分别为57.1%(4/7),33.3%(2/6);新生儿死亡率分别为33.3%(2/6),0(0/5)。期待治疗的患者中,1例出现了弥漫性血管内凝血,并因此终止妊娠。5名接受经颅多普勒超声检查的新生儿,3名存在颅内病变。结论孕中晚期双胎妊娠1胎胎死宫内者,单绒毛膜双胎妊娠者预后较差。对胎死宫内发生时间较早者,可在密切监测下行期待治疗以降低早产的发生率,改善预后。
Objective To investigate the clinical prognosis and treatment of surviving fetus with one fetus of twin pregnancy. Methods Retrospective analysis of 13 cases of twins in the second trimester of pregnancy from January 2000 to June 2009 were delivered in our hospital. Results The incidence of single-fetus fetus with twin pregnancy was 2.83%. Thirteen fetuses with one-fetus fetus died of fetal death, seven were single-chorionic twins and six were twin-chorionic twins. A total of 8 patients received the expectant treatment. The average gestational age of 1 fetus diagnosed in the deceased was 31 + 4 weeks. The incidence of preterm birth (<34 weeks) in twin pregnancies with single fetus was higher than that with twin chorion (57.1%, 4/7, 33.3%, respectively) 6); neonatal mortality rates were 33.3% (2/6), 0 (0/5) respectively. Among the patients awaiting treatment, diffuse intravascular coagulation occurred in 1 patient and pregnancy was terminated. Five neonates underwent transcranial Doppler sonography and three had intracranial lesions. Conclusion In the second trimester of pregnancy, one fetus with single fetus and one fetus with single fetus died of intrauterine infection, and the single chorionic twin pregnancy had a poor prognosis. On the early stage of fetal death occurs, you can closely monitor the downlink pending treatment to reduce the incidence of preterm birth and improve prognosis.