双胎胎儿生长不一致妊娠结局及临床预测

Perinatal Outcome and Clinical Prediction in Discordant Twin Pregnancies

目的分析双胎妊娠中胎儿生长不一致的妊娠结局及临床预测。方法回顾性分析2009年1月～2010年12月分娩的双胎妊娠孕妇199例的临床资料。以双胎胎儿体重差>20%为诊断标准,分为发育不一致组(观察组)和发育一致组(对照组),比较两组分娩前B超提示两胎儿间腹围和脐动脉血流差值及比较两组在妊娠并发症、合并症、分娩情况和围产儿预后等方面的差异。结果①观察组妊娠期高血压、双胎输血综合征的发生率明显高于对照组,两组比较,差异有统计学意义(P<0.05);②观察组小于孕龄儿和围产儿死亡的发生率较对照组高,两组比较差异有统计学意义(P<0.01);③观察组新生儿高胆红素血症、新生儿呼吸窘迫综合征、新生儿进入NICU比率均明显高于对照组,差异有统计学意义(P<0.05或<0.01);④两组中胎儿腹围差>20cm,或脐动脉血流S/D差>0.4的发生比例有明显差异(P<0.05)。结论①发育不一致性双胎妊娠并发症及围生儿患病率和死亡率明显高于发育一致性双胎。发育不一致双胎妊娠主要的并发症为妊娠期高血压、双胎输血综合征、分娩小于孕龄儿、围产儿死亡。双胎中体重轻者围产儿死亡率高。②分娩前B超胎儿腹围差及脐动脉血流S/D值在双胎妊娠中对胎儿协调发育和围产儿预后有较好的预测价值,及早发现和处理双胎发育不一致,是改善胎儿和新生儿预后的关键。

Objective To assess the perinatal outcomes and clinical prediction of growth discordant in twins pregnancy. Methods In this retrospective analysis,199 cases of twin babies delivered in our hospital in the period of January 2009 to December 2010 were investigated and their intrapair birthweight differences were determined. Twin pairs whose birthweight difference was 20% or more were designated as discordant twins. The maternal pregnant complications,perinatal outcomes,intrapair abdominal circumference（AC）and the S/D ratio of umbilical artery were compared between 32 discordant twins（observed group）and 167 concordant twins（control group）. Results The incidence of pregnancy induced hypertension and twin-twin transfusion syndrome in observed group was significantly higher than that in control group,21.87%vs9.58%（P0.05）,and 6.25% vs 0.59%（P0.01）,respectively. The small for gestational age infant and perinatal death were higher in observed group compared to that in control group,（46.88% vs 10.78%,P0.01）and（4.69%vs0.59 %,P0.01）,respectively. There are also significant differences in fetal malformation and S/D0.4 or AC20mm between these two groups. Conclusion Discordant twin gestations was associated with a significantly increased risk of pregnancy induced hypertension,twin-twin transfusion syndrome,perinatal death,and fetal malformation. The smaller twin and severe discordance are risk factors for poor Perinatal outcome. Clinically,attention should be paid to diagnosis earlier,and termination in time is very important for improving the perinatal outcomes.