高龄双胎妊娠孕产妇妊娠结局分析

Pregnancy outcomes in twin pregnancies at advanced maternal age

目的分析高龄双胎妊娠产妇的临床特征,探讨孕产期的管理经验。方法将本院产科2013年1月-2018年1月收治的双胎妊娠产妇262例作为研究对象,年龄≥35岁者67例为高龄组,年龄<35岁者195例为非高龄组,回顾性总结并分析孕产一般情况、孕产期并发症和母婴妊娠结局。结果高龄组与非高龄组体质量指数、初产妇与经产妇比例、自然受孕与辅助生殖受孕、双绒毛膜双羊膜囊(dichorionic diamniotic,DCDA)与单绒毛膜双羊膜囊(monochorionic diamniotic,MCDA)构成比差异无统计学意义(P均> 0.05);高龄组子痫前期[11例(16.4%) vs 14例(7.2%)]、妊娠期糖尿病(gestational diabetes mellitus,GDM)[23例(34.3%) vs 31例(15.9%)]和产后出血[38例(56.7%) vs 42例(21.5%)]发生率均高于非高龄组(P均<0.05),早产率也高于非高龄组[47例(70.1%) vs 106例(54.4%)](P=0.024);两组新生儿窒息、病理性黄疸、感染发生率以及转NICU率差异无统计学意义(P均> 0.05)。结论高龄双胎妊娠产妇的子痫前期、GDM、产后出血和早产风险更高,但新生儿不良结局风险并未显著升高。

Objective To analyze the clinical characteristics of twin pregnancies at advanced maternal age and explore perinatal management. Methods A retrospective analysis involved 262 cases of twin pregnancies in our hospital from January 2013 to January 2018 was performed. Sixty-seven cases( ≥ 35 years) were included in the advanced age group and 195 cases( < 35 years) in the younger age group. The general condition, pregnancy complications and pregnancy outcomes for mother and fetus were compared between the two groups. Results There was no significant difference in body mass index, primipara/multipara, natural pregnancy/assisted reproductive conception, DCDA/MCDA between two groups(all P > 0.05). The incidences of preeclampsia [11 cases(16.4%) vs 14 cases(7.2%)], gestational diabetes mellitus(GDM) [23 cases(34.3%) vs 31 cases(15.9%)], postpartum hemorrhage [38 cases(56.7%) vs 42 cases(21.5%)] and premature delivery [47 cases(70.1%) vs 106 cases(54.4%)] in the advanced age group were higher than those in the younger age group, and the differences were statistically significant(all P < 0.05). While, there was no significant difference in the incidence of neonatal asphyxia, pathological jaundice, infection and NICU conversion between the two groups(all P > 0.05). Conclusion In twin pregnancies, pregnant women with advanced maternal age experience significantly higher risk of preeclampsia, GDM, postpartum hemorrhage and premature delivery. While, the risk of neonatal adverse outcomes dose not increased.