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37例双胎一胎胎死宫内后存活儿预后分析
宋晶;陈奕
0
(首都医科大学附属北京妇产医院)
摘要:
目的:通过分析双胎一胎胎死宫内(SIUFD)后存活儿的预后,探讨不同孕周及绒毛膜性双胎发生SIUFD后不同妊娠结局,并完善SIUFD的监测管理。方法:收集2013年1月1日至2015年12月31日在首都医科大学附属北京妇产医院分娩的SIUFD病例37例(剔除双胎输血综合征病例11例),对SIUFD病例进行回顾性分析,包括SIUFD的发生孕周、存活儿的期待治疗时间、发生死亡的原因及不同孕周和不同绒毛膜性存活儿的预后,并电话随访新生儿生长情况。结果:37例SIUFD的发生时间以孕早期多见,占64.86%(24/37);SIUFD发生后期待治疗的时间最短1天,最长231天,平均116天;死亡原因中脐带及胎盘异常造成的占32.43%(12/37),胎儿畸形占8.11%(3/37);存活胎儿早产(分娩孕周小于37周)的有9例,其中最小孕周32周,足月分娩28例;早产、新生儿窒息、急诊剖宫产、孕期并发症的发生率在单绒毛膜双胎均明显高于双绒毛膜双胎;同时SIUFD发生孕周>13周时其存活胎儿的早产、新生儿窒息、急诊剖宫产的发生率也大于≤13周的SIUFD。对中、晚孕期发生SIUFD的13例病例存活儿近1年的随访,未发现存活胎儿存在神经系统及其他器官的有关损伤表现。结论:SIUFD发生后存活胎儿的预后与SIUFD发生孕周及绒毛膜性有关,虽然本研究中暂未发现发生SIUFD后存活儿在单绒毛膜双羊膜中双胎出现比双绒毛膜双羊膜双胎更高的神经系统不良后遗症,但仍需要长期随访。
关键词:  双胎一胎胎死宫内  新生儿神经系统并发症  胎死宫内原因  
DOI:
基金项目:
Prognostic Analysis of Posterior Delivery in Single Intrauterine Fetal Demise
SONG Jing;CHEN Yi;
(Beijing Obstetrics and Gynecology Hospital,Capital Medical University)
Abstract:
Objective: To analyze the prognosis of twin intrauterine fetal death intrauterine surgery( SIUFD),and to investigate the pregnanct outcomes of SIUFD after different gestational weeks and chorionic twins,and to improve the monitoring and management of SIUFD. Methods: Data from January 1,2013 to December 31,2015 in Beijing Obstetrics and Gynecology Hospital of SIUFD delivered 37 cases( excluding twin transfusion syndrome,11 cases)were retrospectively analyzed,including the incidence of SIUFD gestational weeks,save work time to look for the cause of death,different gestational weeks and chorionic deposit work the prognosis,followed up neonatal growth by telephone.Results: The time of occurrence of SIUFD in this 37 cases of early pregnancy was common,accounted for 64. 86%( 24/37); The period of expectant treatment after SIUFD was 1 day( the shortest),231 days( the longest),and 116 days( average); among the death-caused factors,umbilical cord and placenta abnormality accounted for 32. 43%( 12/37) and fetal malformation accounted for 8. 11%( 3/37); the survival of premature fetus( gestational age less than 37 weeks) were 9 cases,of which a minimum of 32 weeks of gestation,28 cases of full-term birth; premature birth,neonatal asphyxia,emergency caesarean section,pregnancy complications in monochorionic twins were significantly higher than those of in dichorionic twins; SIUFD gestational weeks > 13 weeks survival fetal premature delivery,neonatal asphyxia,emergency cesarean section rate of less than ≤ 13 weeks more than SIUFD.Conclusions: After SIUFD and survival fetal incidence of fetal gestational weeks and chorionicity,although not yet the study found that SIUFD occurred after the adverse neurological sequelae of child survival than dichorionic diamniotic twins higher in monchorionic twin dichorionic twinw,but still need long-term follow-up.
Key words:  Singleintrauterinefetaldemise  Neonatalnervoussystemcomplications  Intrauterinefetaldeath

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