双胎妊娠一胎胎死宫内后存活儿的近期预后

Short-term prognosis of the co-twin who survives after single intrauterine fetal demise

摘要:

目的 分析双胎妊娠一胎胎死宫内（sIUFD）后存活儿的近期预后。方法 以sIUFD后存活儿52例为病例组，同时选取同期收治的104例胎龄匹配、不伴有sIUFD双胎妊娠分娩的双胎之一为对照组，对其临床资料进行比较分析。结果 52例sIUFD后存活儿中，早产儿42例（80.8%），合并脑损伤13例（25.0%），新生儿期死亡3例（5.8%）。sIUFD组的羊水异常（羊水粪染或血性羊水、羊水过多或过少）、脐带异常（脐带扭转或脐带绕颈）及胎盘异常（前置胎盘或胎盘早剥）的发生率、出生窒息率、出生时贫血或红细胞增多症发生率及出生时凝血功能障碍发生率均明显高于对照组（P < 0.05）；sIUFD组住院期间出现院内感染及脑损伤的发生率明显高于对照组（P < 0.05）。结论 双胎妊娠发生sIUFD后会增加存活儿新生儿期并发症的发生率，对于sIUFD存活儿，应加强产前评估，并进行远期预后随访。

Abstract:

Objective To investigate the short-term prognosis of the co-twin who survives after single intrauterine fetal demise (sIUFD). Methods A total of 52 infants who survived after sIUFD were enrolled as the case group, and 104 twins, matched for gestational age, from a pair of live-born twins without sIUFD were enrolled as the control group. Related clinical data were compared between the two groups. Results Among the 52 infants who survived after sIUFD, 42 (80.8%) were preterm infants, 13 (25.0%) had brain injury, and 3 (5.8%) died in the neonatal period. Compared with the control group, the case group had significantly higher incidence rates of meconium stained amniotic fluid/bloody amniotic fluid/polyhydramnios/hypamnion, torsion of cord/nuchal cord, and placenta previa/placenta abruption, as well as significantly higher incidence rates of birth asphyxia, anemia or polycythemia at birth, and coagulation disorder at birth (P < 0.05). The case group also had significantly higher incidence rates of nosocomial infection and brain injury than the control group during hospitalization (P < 0.05). Conclusions There is an increase in the incidence rate of complications in the co-twin who survives after sIUFD. Prenatal evaluation and long-term follow-up should be performed for the surviving co-twin.