Liveborn Twin with Intrauterine Death of One Twin: Report of Two Cases

雙胞胎子宮內單胎死亡後之存活兒：兩病例報告

蘇百弘(Bai-Horng So) ； 田村正德(Masanori Tamura) ； 鴨下重彥(Shigehiko Kamoshita)

《Acta Paediatrica Sinica》 35卷4期 (1994/08) Pp. 312-318

https://doi.org/10.7097/APS.199408.0312

摘要

雙胎妊娠比單胎妊娠有較大的死亡率和罹病率。在雙胎之一發生子宮內胎兒死亡(IUFD)後，存活的另一胎兒的死亡率及罹病率更是大爲增加。其中病因大多歸之於雙胎間輸血現象。做爲輸血側的胎兒，大多有循環血液量減少、貧血及合併生長遲滯，甚至嚴重時發生胎兒死亡。做爲受血側的胎兒，則大多有循環血液量過多及多血症，其體重比輸血側胎兒來得大。我們報告兩例雙胎之一兒發生子宮內胎兒死亡後，在存活兒發生的併發症。這兩個病例都是單一絨毛膜性雙胎妊娠。
第一例，妊娠29週6天，男嬰，剖腹産，存活嬰兒體重1054g，死胎嬰兒體重722g。出産後，存活嬰兒臨床上有呼吸窘迫症候群(RDS)，貧血及兩側腦室週圖超音波高回音像。第2例爲女嬰，妊娠26週2天，剖腹産，存活嬰兒體重850g，死胎嬰兒體重804g，兩者皆有胎兒水腫的現象。存活嬰兒臨床上有呼吸窘迫症候群，嚴重的貧血低蛋白血症。
我們認爲在雙胎妊娠的處理上，必須在妊娠早期以超音波檢查做出的卵性診斷，如果是一絨毛膜性雙胎，則必須對胎兒的成長及雙胎間輸血現象的有無密切的監視。如果不幸發生一兒子宮內死亡，另一存活嬰兒發生併發症的情形就很難預測。臨床上必須做適當的準備，如輸血，白蛋白補充及catecholomine輸注等，並且在存活嬰兒出生後，儘快開始治療。
對於這兩個病例的臨床表現及可能病因，我們參攷文獻加以檢討並提出報告。

關鍵字

子宮內胎兒死亡 ； 單一絨毛膜性雙胎 ； 雙胎間輸血 ； 側腦室週圖高超音波回音像及側腦室週圖白質軟化症

並列摘要

Twin pregnancies carry a greater mortality and morbidity rate than singleton pregnancies. In case of an intrauterine fetal death (IUFD), the risk of mortality and morbidity of the surviving twin is increased. The pathogenesis is usually due to twin to twin transfusion. The donor twin is hypervolemic, anemic and often shows a growth retardation or even severe enough to cause an IUFD. The recipient twin is hypervolemic, polycythemic and weighs more than its co-twin. In this paper we reported two cases of livebom twin complicated by an IUFD of its co-twin. Both cases were monochorionic twins. The first case was born at 29 weeks and 6 days of gestation, a male infant weighed 1054 g. His co-twin was stillbom and weighed 722 g. At birth the surviving infant showed respiratory distress syndrome (RDS), anemia and bilateral periventricular echogenicity (PVE). The second case was a female infant with a gestational age of 26 weeks and 2 days and weighed 850 g. Her stillborn co-twin weighed 804 g. Both twins showed signs of hydrops, and the livebom infant had RDS, marked anemia (Hb 6 g/dl) and hypoalbuminemia. We will discuss the possible patho genesis in our cases and also review some literature.

並列關鍵字

Intrauterine fetal death (IUFD) ； Monochorionic twins ； Twin to twin transfusion ； Periventricular echogenicity and leukomalasia (PVE and PVL)