双胎妊娠分娩时机与新生儿窒息关系研究

Study on the relationship between the timing of delivery in twin pregnancies and neonatal asphyxia

目的探讨双胎妊娠分娩时机与新生儿窒息之间的关系。方法对国内10家医院2013年分娩的2819例双胎妊娠临床资料进行回顾性分析,统计双胎各孕周分娩比例;比较各孕周新生儿出生体重、新生儿窒息率。结果 2819例双胎妊娠晚期流产率为7.31%(206/2819),主要集中在妊娠26~27+6周;早产率为64.31%(1813/2819);28周后活产新生儿平均体重:大胎儿为(2438.4±527.5)g,小胎儿为(2155.9±517.1)g,妊娠39周后活产儿出生体重增长趋势下降;活产新生儿窒息率:大胎儿为5.38%(138/2565),小胎儿为6.28%(152/2427),妊娠29~29^(+6)周与30~30^(+6)组周、34~34^(+6)周与35~35^(+6)周组差异有统计学意义(P<0.05)。结论双胎流产发生孕周主要集中在26~27^(+6)周。随妊娠周数增加,新生儿窒息率逐渐下降;妊娠30周前新生儿窒息比例高,妊娠35周后新生儿窒息率显著下降。对无明显并发症的双胎妊娠应尽可能延长孕周至36~38^(+6)周,但不宜超过39周。

Objective To analyze the current timing of delivery in twin pregnancies,to investigate the timing of delivery in twin pregnancies and neonatal asphyxia. Methods A retrospective study was conducted on 2819 cases of twin pregnancy in 10 hospitals of China in 2013,and the average birth weight and neonatal asphyxia were compared.Results The late abortion rate was 7.31%（206/2819）,mainly concentrated in 26-27^（＋6） weeks gestational weeks; preterm delivery rate was 64.31%（1813/2819）; The average birth weight of live birth after 28 weeks： high weight newborn was（2438.4 ± 527.5）g,low weight newborn was（2155.9±517.1）g; The growth trend of live births was decreased after 39 weeks gestation. Neonatal asphyxia rates： high birth weight newborn was 5.38%（138/2565）and low weight new born was 6.28%（152/2427）;Neonatal asphyxia rate of low birth weight newborn were statistically significantly different between 29-29^（＋6） and 30-30^（＋6） gestational weeks,34-34^（＋6） and 35-35^（＋6） gestational weeks（P0.05）.Conclusion The late abortion of twins is mainly concentrated in 26-27^（＋6）weeks. The rate of asphyxia decreased gradually,the rate of neonatal asphyxia was high before 30 gestational weeks and significantly decreased after 35 gestational weeks. The timing of delivery of twins with no obvious complications should be extended to 36-38^（＋6） gestational weeks,but no more than 39 gestational weeks.