背景:双胎妊娠与围产期发病风险增加相关。此外,如果一个双胞胎发生宫内死亡,它增加了围生期和出生后存活的双胎的发病率。
目的:本研究的目的是确定双胎妊娠中单胎宫内死亡(SIUFD)的发生率,以及根据存活的双胎并发症的维度定义的胎儿结局。
方法:从医学研究生学院中央记录部(CRD)的劳动室记录中回顾性地收集了五年(从2015年到2019年)的双胎妊娠数据。教育和研究,昌迪加尔,印度。对SIUFD病例进行了单独研究,分娩后对新生儿进行了长达3至8年的随访。纳入标准是妊娠14周后双胎妊娠的SIUFD,妊娠早期超声检查预先定义的绒毛膜性。排除标准为高阶妊娠和单羊膜双胎。
结果:在研究期间共进行了1246例(4.273%)双胎分娩。其中,107例(8.587%)妊娠患有SIUFD,双胞胎在子宫内存活。其中,77例(72%)为双胎双胎妊娠,30例(28%)为单胎双胎妊娠。SIUFD的发生率为8.5%。早产是我们研究中观察到的最常见的并发症,在DCDA和MCDA双胞胎中分别有53.5%和58.3%的参与者中发现。分别。在29.2%的SIUFD单绒毛膜双胞胎中发现了存活双胞胎的早期新生儿死亡(生命的24小时内)。妊娠<28周时SIUFD导致存活双胞胎的早期新生儿死亡更多。神经发育障碍(脑瘫,发育迟缓,癫痫)在出生后的人口中为7.5%(n=93)。
结论:双胎妊娠合并SIUFD的早产发生率增加,增加了幸存的双胞胎的新生儿死亡,和神经发育障碍(脑瘫,发育迟缓,癫痫)。妊娠<28周时的单发性和SIUFD与同胎中新生儿死亡增加有关。神经发育障碍的发病率与绒毛膜不直接相关,但是单绒毛膜组的发育迟缓更为深刻。
BACKGROUND: Twin pregnancy is associated with an increased risk of perinatal morbidity. Besides, if intrauterine death of a single twin occurs, it increases the morbidity of the surviving co-twin perinatally and postnatally.
OBJECTIVE: The objective of this study was to determine the incidence of single intrauterine fetal death (SIUFD) in a twin pregnancy and fetal outcome defined in dimensions according to the complications in the surviving co-twin.
METHODS: Data on twin pregnancies were collected retrospectively for a period of five years (from 2015 to 2019) from the labour room records of the Central Records Department (CRD) at the Postgraduate Institute of Medical Education and Research, Chandigarh, India. Cases with SIUFD were studied individually and neonatal follow-up was taken post delivery for up to three to eight years. Inclusion criteria were SIUFD in twin pregnancies after 14 weeks gestation, chorionicity pre-defined by early trimester ultrasonography. Exclusion criteria were higher-order pregnancy and monoamniotic twins.
RESULTS: A total of 1246 (4.273%) twin deliveries were conducted in the study period. Of these, 107 (8.587%) pregnancies had SIUFD with co-twin surviving in utero. Among these, 77 (72%) were dichorionic diamniotic (DCDA) twin pregnancies and 30 (28%) were monochorionic diamniotic (MCDA) twin pregnancies. The incidence of SIUFD was 8.5%. Preterm birth was the most common complication observed in our study and was found in 53.5% and 58.3% of participants in DCDA and MCDA twins, respectively. Early neonatal death (within 24 hours of life) of the surviving twin was found in 29.2% monochorionic twins with SIUFD. SIUFD at < 28 weeks gestation led to a greater number of early neonatal deaths of surviving twins. The incidence of neurodevelopmental disorders (cerebral palsy, developmental delay, epilepsy) in our population after birth was 7.5% (n=93).
CONCLUSIONS: Twin pregnancies with SIUFD have an increased incidence of preterm labour, increased neonatal death of the surviving twin, and neurodevelopmental disorders (cerebral palsy, developmental delay, epilepsy). Monochorionicity and SIUFD at <28 weeks gestation are associated with increased neonatal deaths in co-twin. The Incidence of neurodevelopmental disorders is not directly associated with chorionicity, but developmental delay is more profoundly seen in the monochorionic group.