三胎及三胎以上妊娠围产儿管理与结局分析

Perinatai management and outcomes of triplet and multiple pregnancy

目的探讨三胎及三胎以上妊娠围产儿的临床处理和结局。方法回顾性分析1996年至2005年17例三胎及三胎以上妊娠共55例围产儿的管理方法及结局。结果前5年（1996年至2000年）和后5年（2001年至2005年）的规律产前检查率（1／6，8／11）差异有统计学意义（P〈0．05）；各种产科并发症的发生率差异无统计学意义；分娩时平均孕周分别为（32．7±2．8）周和（35．1±1．9）周，差异有统计学意义（P〈0．05）；新生儿平均出生体重分别为（1561±471）g和（1987±453）g，差异有统计学意义（P〈0．01）。剖宫产率后5年高于前5年，但差异无统计学意义。两组新生儿并发症主要为肺透明膜病、新生儿窒息、感染性疾病、颅内出血、肺出血，其发生率后5年较前5年明显下降，差异均有统计学意义（P〈0．05）；呼吸暂停、低体温发生率后5年较前5年明显下降，但差异无统计学意义。前5年新生儿死亡12例（60％），后5年新生儿死亡8例（23％），差异有统计学意义（P〈0．01）。结论规律产前检查，积极防治妊娠并发症，提前住院以延长孕周，增加出生体重，提倡产儿联合，重视早产儿并发症的防治，可以改善三胎及三胎以上妊娠围产儿的结局。

Objective To analyze chnical management and outcomes of perinatal fetuses born in triplet and multiple pregnancy. Methods Data of clinical management and outcomes of 55 perinatal fetuses born during 1996 to 2005 by women with triplet and multiple pregnancy were analyzed retrospectively. Results Antenatal check-up was performed regularly for 1/6 of those pregnant women during 1996 to 2000, as compared to that of 8/11 during 2001 to 2005 （P 〈0.05）. No significant difference in incidence of varied obstetric complications was found between those during 1996 to 2000 and during 2001 to 2005. Average gestational week at birth was （32. 7 ±2. 8 ） and （35. 1±1.9 ） weeks （P 〈 0. 05 ）, and average birth weight was （ 1561±471 ） grams and （ 1987 ± 453 ） grams （P 〈 0. 01 ）, respectively for them during 1996 to 2000 and during 2001 to 2005. Caesarean section was performed more for the pregnant women in the earlier first five years than in the later five years, but not reaching statistical significance. Incidence of neonatal complications significantly decreased in the later five years than that in the earlier five years, including hyaline membrane disease , neonatal asphyxia , infectious diseases, intracranial hemorrhage and pulmonary hemorrhage（P 〈0. 05）, but difference in incidence of apnea and low body temperature between the earlier and later five years did not reach statistical significance. Perinantal mortality was 8 in 35 births in the later five years, as compared to that of 12 in 20 births in earlier five years （P 〈0.01）. Conclusions Outcomes of perinatal fetuses in triplet and multiple pregnancy can be improved by combined action of obstetricians and pediatricians, including regular antenatal examination, active prevention and treatment for pregnant complications and preterm infant diseases, earlier admission waiting for delivery to prolong gestational weeks and increase birth weight, and applying antenatal dexamethasone therapy.