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産兒損失을 中心으로한 雙胎兒妊娠의 臨床的 考察

Twin Pregnancy

대한산부인과학회지 1965년 8권 3호 p.17 ~ 21
鄭元永/Chung, Wun Yong
白成鉉/文載薰/Baik, Sung Hyun/Moon, Zae Hoon

Abstract


It is reported that the perinatal mortality in twinpregnancy is high, and that the second twin is lost more often than the first.
In the present study, we submitted for analysis 101 cases of twin pregnancy admitted to Obstetric Ward, N.M.C. among 5,687 deliveries from January 1959 to the end of 1964. Total number, of perinatal deaths was 25, excluding 8 of less than 28 weeks gestation. The perinatal mortality was 127, per 1,000 deliveries. We summerized the result as follows:
1) There were ; eighteen primigravida and eighty - three multipara. Primigravida have a slightly higher -rate of fetal mortality than multipara.
2) Birth weight of the infants was closely related to the main cause of death in each case.,One hundred per cent of fetal loss occurred in infants weighing under 1,000 gm, whereas the fetall loss among 1,000-2,000 group was 43.8% of the first twin and 34.8% of ´the second one, and 7.9%, of the first, 10.0% of the second respectively among the group 2,000-2,500g. In the group weighing more than 2,500 g, the fetal loss was 2.3 % of the 1st twin, and 7.1 % for the second twin group. The critical birth weight in connection with fetal loss would appear to be 2,000g.
3) As to the time interval between delivery of the first and the second infant in our series, two thirds of the second twin were delivered within 30 minutes with 12.8% mortality. However, fetal mortality of the second twin was 100% after 60 minutes in 3 cases.
4) In 51 registered cases, 4(7.8%) cases were diagnosed for twins after the first twin was delivered.
In 50 unregistered cases, 10(20%) cases were diagnosed after the first twin. The importance of diagnosing the presence of the second twin before administering any oxytotic drug cannot be overemp hasized. On 3 occasions where such drugs were administered, both the second infants subsequently died.
5) If 10.0 g/100 ml hemoglobin is used as a tentative borderline value for anemia of 51 registered cases, only 10 were anemic, while 31 of unregistered cases had moderate or severe anemia.
6) Twenty-one cases were under care for toxemia among 51 of registered cases, and 24 in 50 unregistered. There were no evidence of eclampsia in the registered cases. whereas 6 of the unregistered toxemic patients had eclamptic fit.
7) The fetal loss of second twin showed slightly high mortality rate in breech than cephalic delivery in ourseries. In two cases in our series, total hysterectomy was carried out due to atonic bleeding.
There were 4 cases of congenital anomalies thoracopagus, anencephalus and heart anomaly.

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