目的　探讨双胎妊娠中一胎儿宫内死亡的原因及对存活胎儿、孕妇的影响和处理。方法　回顾性分析 9例双胎妊娠一胎死宫内的原因及处理。结果　 2例孕中期双胎妊娠一胎死宫内孕妇 ,足月顺产死亡胎儿呈纸样儿。 1例孕 32 + 4 周双胎之一宫内死亡孕妇行期待疗法 ,孕 36周存活胎儿行剖宫产。 1例孕35 + 5周双胎之一死亡孕妇可疑早期DIC即行剖宫产。 2例分别孕 35、36周双胎之一死亡伴宫内感染孕妇行剖宫产。双胎之一胎儿宫内死亡的主要原因 :胎儿畸形 2例 ,胎盘因素 3例 ,脐带因素 2例 ,原因不明 2例。结论　孕早、中期双胎之一胎儿宫内死亡存活的胎儿预后良好 ;孕龄较大 ,双胎之一胎儿死亡 ,可增加存活胎儿及孕妇的患病率和病死率 ,应加强存活胎儿及孕妇的监护 ,选择分娩时机和方式。对孕龄 <34周双胎之一胎儿死亡者可行期待疗法 ,而对孕龄≥ 34周者应考虑终止妊娠 Objective To investigate the causes of fetal intrauterine fetal death in twin pregnancies and their effects on surviving fetus and pregnant women. Methods Retrospective analysis of nine cases of twin pregnancy in a dead cause and treatment. Results 2 cases of second trimester twin pregnancies of a fetus dead pregnant women, full-term birth of the fetus was paper-like children. One case of 32 +4 weeks of pregnancy one of the twins died of intrauterine pregnancy expectant treatment, 36 weeks pregnant surviving cesarean section. One case of 35 +5 weeks pregnant one of the twins died of suspected pregnant women early DIC cesarean section. Two cases were 35 and 36 weeks pregnant respectively, one of twins died of uterine infection with intrauterine pregnancy cesarean section. One of the twins The main causes of fetal death: 2 cases of fetal malformations, 3 cases of placental factors, 2 cases of umbilical cord factors, 2 cases of unknown cause. Conclusions Fetal embryo surviving fetus with one fetus in early pregnancy and in the middle term has a good prognosis. Fetal pregnancy with larger gestational age and fetal death may increase the prevalence and mortality of surviving fetuses and pregnant women. Pregnant women’s custody, choose the timing and mode of delivery. Pregnancy <34 weeks of twins, one of the fetal death expectant treatment is expected, and for gestational age ≥ 34 weeks should consider termination of pregnancy