Kilby M D, Govind A, O'Brien P M
Academic Department of Obstetrics, Keele University, North Staffordshire, United Kingdom.
Obstet Gynecol. 1994 Jul;84(1):107-9.
To examine the perinatal and maternal outcomes in twin pregnancies when a single intrauterine death occurs.
This was a retrospective, observational study. Comparison was made to viable twin pregnancies.
Of a total 34,804 live deliveries, 342 were documented as twin births at a gestation of greater than 20 weeks (incidence 0.98%). Of the twin pregnancies over this period, 20 (5.85%) were complicated by a single intrauterine death. There was an increase in the incidence of congenital structural abnormalities among those twins dying in utero as compared to uneventful twin pregnancies (25 versus 0.3%; P < .001). A significant proportion of these twin pregnancies had monochorionic placentas (35 versus 9%; P < .001) and were admitted to special care units (70 versus 5.6%; P < .001) as compared to the normal twin sample. Maternal morbidity has previously been described as being increased. Although there was an increased risk of nonproteinuric and mild pregnancy-induced hypertension, no adverse maternal effects of conservative management were noted in this study.
The risk of a single fetal death in twin pregnancies is increased with a monochorionic placenta or a structural abnormality. Conservative management and regular surveillance seem advisable.
研究单胎宫内死亡时双胎妊娠的围产期及母体结局。
这是一项回顾性观察研究。与存活的双胎妊娠进行比较。
在总共34804例活产中，342例记录为孕周大于20周的双胎分娩（发生率0.98%）。在此期间的双胎妊娠中，20例（5.85%）并发单胎宫内死亡。与正常双胎妊娠相比，宫内死亡双胎的先天性结构异常发生率增加（25%对0.3%；P <.001）。与正常双胎样本相比，这些双胎妊娠中有很大比例为单绒毛膜胎盘（35%对9%；P <.001），且入住特殊护理病房的比例更高（70%对5.6%；P <.001）。先前已描述母体发病率会增加。尽管非蛋白尿性和轻度妊娠高血压的风险增加，但本研究未发现保守治疗对母体有不良影响。
单绒毛膜胎盘或结构异常会增加双胎妊娠中单胎胎儿死亡的风险。保守治疗和定期监测似乎是可取的。
