双胎妊娠合并先兆子痫24例回顾性分析

Retrospective Analysis of 24 Cases with Twin Pregnancy Complicated Preeclampsia

目的:对24例双胎妊娠合并先兆子痫患者的临床资料进行回顾性分析,探讨先兆子痫对双胎妊娠母婴结局的影响。方法:回顾性分析广州市妇女儿童医疗中心3年间收治的双胎合并先兆子痫24例临床资料,以同期单胎妊娠合并先兆子痫为对照组,综合比较其发病情况、分娩方式、母婴并发症及结局。结果:双胎妊娠并发先兆子痫的发病率高于单胎妊娠;双胎组的剖宫产率,发生HELLP综合征、胎盘早剥、胎儿窘迫、胎儿生长发育迟缓(fetal growth retardation,FGR)、妊娠期糖尿病、肺水肿等并发症的发生率与单胎组比较,差异无统计学意义(P>0.05),但产后出血率明显高于单胎组(P<0.05);双胎组新生儿发生贫血、肺炎、黄疸、呼吸窘迫综合征(respiratory distresssyndrome,RDS)、新生儿缺氧缺血脑病(hypoxic-ischemic encephalopathy,HIE)、颅内出血、新生儿窒息及围产儿死亡的机率与单胎组比较,差异无统计学意义(P>0.05),但发生小于胎龄儿(small for gestationalage,SGA)的机率明显高于单胎组,差异有统计学意义(P<0.05)。结论:双胎妊娠并发先兆子痫更易发生多种母胎并发症,及时发现和处理先兆子痫,积极防治并发症,可改善母婴预后。

Objective： To analyze the data of 24 cases of twin pregnancy complicated preeclampsia retrospectively, and determine the effect of twin pregnancy complicated preeclampsia on pregnancy outcome. Method： Retrospectively to analyze the 24 cases of twin pregnancy complicated preeclampsia in Guangzhou Women and Children＇ s Medical Center in three years. All the cases were compared to the single pregnancy complicated preeclampsia during the same period. The incidence of severe preeclampsia, delivery mode, prenatal complications and outcomes were analyzed respectively. Result： The incidence of preeclampsia in twin group was higher than that of the single group. There was no statistical difference between the two group on the cesarean rate, and incidences of HELLP syndrome, abruptio placenta, fetal distress, fetal growth retardation, complicated with gestational diabetes mellitus（GDM）, pulmonary edema（P〉0.05）. However, the incidence of postpartum hemorrhage in twin group was higher than that of the single（P〈0.05）. The incidence of neonatal anemia, pneumonia, jaundice, respiratory distress syndrome, hypoxic-ischemic encephalopathy, intracraniai hemorrhage, asphyxia neonatorum, and perinatal mortality in the twin pregnancy group was not significantly higher than those in the single group（P〉0.05）, but significantly higher than that in small for gestationai age（P〈0.05）. Conclusion： When twin pregnancy complicated with preeclampsia, the incidence of prenatal complications are higher. Prompt diagnosis, positive treatment, and intensive prevention of complications are the keys to the better change of the pregnancy outcome.