Vial Y, Hohlfeld P
Département de Gynécologie-Obstétrique, Centre Hospitalier Universitaire Vaudois, Lausanne.
Praxis (Bern 1994). 1999 Sep 2;88(36):1435-8.
The loss of a fetus in a multiple pregnancy is relatively frequent. The main risk factor is a monochorionic twin pregnancy. If fetal loss occurs after 16 weeks of pregnancy, the survivor is also at increased risk of intrauterine death. In monochorionic twins, the risk of neurological sequelae can be as high as 25%. These lesions are due to acute episodes of hypoperfusion immediately following the death of the co-twin. Maternal complications including coagulation disorders are rare. The management will vary according to the type of placenta, the gestational age and the condition of the surviving twin. When the last trimenon has been reached, rapid delivery is probably the safest management. In monochorinoic biamniotic twins, the risk to the survivor often justifies the induction of delivery between 28 and 32 weeks of gestation after steroids have been administered. In most cases, before the 28th week of gestation, a conservative management will be proposed. In monochorionic monoamniotic twins, immediate delivery should be considered as soon as fetal viability is reached.
多胎妊娠中胎儿丢失相对常见。主要危险因素是单绒毛膜双胎妊娠。如果胎儿丢失发生在妊娠16周后，存活胎儿发生宫内死亡的风险也会增加。在单绒毛膜双胎中，神经后遗症的风险可高达25%。这些损伤是由于双胎之一死亡后立即发生的急性灌注不足所致。包括凝血障碍在内的母体并发症很少见。管理方法将根据胎盘类型、孕周和存活胎儿的状况而有所不同。当妊娠晚期到来时，快速分娩可能是最安全的管理方法。在单绒毛膜双羊膜囊双胎中，对存活胎儿的风险通常使得在给予类固醇后于妊娠28至32周之间引产是合理的。在大多数情况下，在妊娠28周之前，会建议采取保守管理。在单绒毛膜单羊膜囊双胎中，一旦达到胎儿存活能力，应立即考虑分娩。
