Axt R, Mink D, Hendrik J, Ertan K, von Blohn M, Schmidt W
Department of Obstetrics and Gynecology, University of the Saarland, Homburg, Germany.
J Perinat Med. 1999;27(3):221-7. doi: 10.1515/JPM.1999.031.
To study the maternal and neonatal outcome of twin pregnancies complicated by the intrauterine death of one fetus after 20 weeks of gestation.
Retrospective, observational study of 7 twin pregnancies out of 185 twin pregnancies with the diagnosis of a single intrauterine death over a 5-years period in a university hospital.
The incidence of single fetal death in twin gestation after 20 weeks was 3.8% in the study population with a high incidence of intrauterine growth retardation (IUGR) of the remaining fetus and preeclampsia in the further course of pregnancy. The incidence of preterm delivery was 71% with a mean gestational age of 33.0 +/- 1.0 weeks. The median interval from diagnosis of single fetal death to delivery was 10.2 +/- 4.1 days (range 1-28 days). 5 of 7 (71%) cases were delivered by cesarean section for standard obstetrical reasons. Neither perinatal nor neonatal death of the remaining twin were observed. Two cases of neurologic injury were diagnosed after delivery by ultrasound and MRI. No maternal coagulopathy related to single fetal death occurred.
Expectant management of single fetal death in twin pregnancies might be advisible under close surveillance of both, mother and the surviving fetus.
研究妊娠20周后双胎妊娠合并一胎宫内死亡的母婴结局。
对一所大学医院5年内185例双胎妊娠中诊断为单胎宫内死亡的7例双胎妊娠进行回顾性观察研究。
研究人群中，妊娠20周后双胎妊娠单胎死亡的发生率为3.8%，剩余胎儿宫内生长受限（IUGR）发生率高，且在后续妊娠过程中发生先兆子痫。早产发生率为71%，平均孕周为33.0±1.0周。从诊断单胎死亡到分娩的中位间隔时间为10.2±4.1天（范围1 - 28天）。7例中有5例（71%）因标准产科原因行剖宫产分娩。未观察到剩余双胎的围产期或新生儿死亡。产后经超声和MRI诊断出2例神经损伤。未发生与单胎死亡相关的母体凝血功能障碍。
在对母亲和存活胎儿进行密切监测的情况下，对双胎妊娠单胎死亡进行期待治疗可能是可取的。
