Jaw C S, Li Y T, Hsu K P, Yeh K C, Tu F C, Tsui M S
Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital.
Zhonghua Yi Xue Za Zhi (Taipei). 1993 Apr;51(4):309-13.
From 1982 to 1991, six twin pregnancies, in which one of the fetuses died in utero, have been encountered. The causes of antepartum death in twin gestation could be identified in four cases; one with abruptio placenta, one with twin-to-twin transfusion syndrome, one with twisting of cord and one with velamentous insertion of cord. All six surviving infants had no abnormality in the follow-up of two to seven years. Although a conclusion about the prognosis could not be drawn from such a small series, these good results may have resulted from 1) 2 cases having been dichorionic twins, and 2) the other 4 monochorionic twins of 31-36 gestation weeks were delivered 1 to 5 days after the diagnosis. Conservative treatment was usually suggested until the fetal lung was mature enough for induction of labor. One case was treated after the death of its counterpart with tocolytic agent for a further 15 days because of prematurity. Cesarean section was performed finally for fetal distress resulting from chronic abruption placenta. The other five cases were delivered through vaginal route. According to experience as well as literature review, to improve the prognosis, obstetricians should be familiar with the management of one fetal death in twin pregnancy, especially in those with monchorionic twins.
1982年至1991年期间，共遇到6例双胎妊娠，其中1个胎儿在子宫内死亡。双胎妊娠产前死亡的原因在4例中得以明确；1例为胎盘早剥，1例为双胎输血综合征，1例为脐带扭转，1例为帆状脐带附着。所有6名存活婴儿在2至7年的随访中均无异常。尽管如此小的病例系列无法得出关于预后的结论，但这些良好结果可能源于：1）2例为双绒毛膜双胎；2）其他4例单绒毛膜双胎，妊娠周数为31 - 36周，在诊断后1至5天分娩。通常建议采取保守治疗，直至胎儿肺成熟到足以引产。1例因早产，在其双胎之一死亡后，用宫缩抑制剂又治疗了15天。最终因慢性胎盘早剥导致胎儿窘迫而行剖宫产。其他5例经阴道分娩。根据经验以及文献回顾，为改善预后，产科医生应熟悉双胎妊娠中1个胎儿死亡的处理，尤其是单绒毛膜双胎。
