双胎及单胎妊娠围产儿死亡分析

ANALYSIS FOR PERINATAL MORTALITY OF TWIN PREGNANCIES AND SINGLETON PREGNANCY.

目的：探讨双胎及单胎妊娠不同分娩孕周及出生体重围产儿死亡率及影响因素.方法：采用病例回顾性研究的方法,分析我院1989～1998年双胎妊娠155例及单胎妊娠10 599例围产儿死亡情况.结果：排除畸形死亡后,双胎围产儿总死亡率较单胎升高,差异有统计学意义（χ^2=94.71,P＜0.001）.在分娩孕周≥37周及32～36＋6周,双胎围产儿死亡率高于单胎,差异有统计学意义（分别为χ^2=9.85,P＜0.01,χ^2=7.61,P＜0.01）,而当分娩孕周＜32周时,双胎围产儿的死亡率低于单胎,差异有统计学意义（χ^2=12.93,P＜0.0001）.在出生体重≥2 500 g时,双胎围产儿死亡率高于单胎,差异有统计学意义（χ^2=9.06,P＜0.01）.而当出生体重在1 500 g及＜1 500 g时,则双胎儿与单胎围产儿死亡率差异无统计学意义（分别为χ^2=0.182,P＞0.05;χ^2=1.536,P＞0.05）.双胎或单胎围产儿死亡率均随分娩孕周及出生体重的增加而降低.结论：分娩孕周及出生体重是影响围产儿死亡率的重要原因.双胎围产儿宫内生长不同于单胎,尚需进一步研究适用于双胎妊娠的最佳分娩孕周及出生体重标准.

Objective： To investigate the influential factors for perinatal mortality of twin pregnancies and singleton pregnancy. Methods： The retrospective analysis included data on a total of 155 twin pregnancies and 10 599 - singleton pregnancy delivered at the Department from 1989 to 1998. Results： Excluding congenital deformities, the total perinatal mortality of twin preganancies was significantly higher than.that of singleton pregnancy （χ^2 =94.71, P〈0.001）. Perinatal mortality of twin pregnancies in≥37 gestational weeks group and 32 to 36^＋6 gestational weeks group were significantly higher than that of singleton pregnancy （χ^2 = 9.85, P〈0.01; χ^2=7.61, P〈0.01, respectively）, however, in〈32 gestational weeks group the result was reverse （χ^2= 12.93, P〈0.0001）. Perinatal mortality of twin pregnancies in ≥2 500 g birth weight group was significantly higher than that of singleton pregnancy, but in 1 500-g and 〈 1 500 g birth weight group, their mortality had no significantly difference （χ^2 = 0.182, P〉0.05; χ^2= 1.536, P〉0.05, respectively）. Perlnatal mortality of twin and singleton pregnancy decreased with gestational weeks and birth weight increasing. Conclusions： Perlnatal mortality is rnarkedly influenced by gestational weeks and birth weight. Compared with singleton pregnancy, twin pregnancies have their own characteristics. Further studies are necessary to investigate the standard of suitable gestational weeks and birth weight for twin pregnancies.