双胎妊娠分娩时机及分娩方式与新生儿窒息的关系

Relationship between delivery opportunity and modes of twin pregnancy and neonatal asphyxia

目的探讨双胎妊娠分娩时机及分娩方式与新生儿窒息之间的关系。方法回顾性分析2013年7月-2016年6月在该院住院的双胎妊娠孕妇540例,统计各孕周分娩比例;比较各孕周新生儿出生体重及新生儿窒息发生率。结果 540例双胎妊娠中,早产323例,早产率59.81%,主要集中在妊娠36~37^(+6)周;28周后活产新生儿平均体重:大胎儿(2 407.85±446.86)g,小胎儿(2 138.00±445.31)g;活产新生儿窒息发生率:大胎儿2.04%(11/539),小胎儿6.43%(34/529)。32~33^(+6)周、28~33^(+6)周阴道分娩组和剖宫产组新生儿窒息率比较,差异有统计学意义(P<0.05);28~33^(+6)周阴道分娩组和剖宫产组小胎儿窒息发生率比较,差异有统计学意义(P<0.05);34~35^(+6)周剖宫产组大胎儿和小胎儿窒息发生率比较,差异有统计学意义(P<0.05);28~31^(+6)周阴道分娩组大胎儿和小胎儿窒息发生率比较,差异有统计学意义(确切概率P=0.033),32~33^(+6)周组和34~35^(+6)周组新生儿窒息发生率比较,差异有统计学意义(P<0.05)。结论双胎妊娠32~33^(+6)周终止妊娠,剖宫产新生儿窒息发生率低于阴道分娩,可改善小胎儿的妊娠结局。

Objective To explore the relationship between delivery opportunity and modes of twin pregnancy and neonatal asphyxia. Methods A retrospective study was conducted among 541 cases of twin pregnancy in the hospital from July 2013 to June 2016, the prapor- tions of delivery cases during different gestational weeks were calculated, neonatal birth weight and incidence rates of neonatal asphyxia dur- ing different gestatinnal weeks were compared. Results The rate of preterrn delivery was 59. 81% （323/540） , which mainly concentrated during 36-37＋6 gestational weeks. The average birth weight of high birth weight neonates and low birth weight neonates after 28 gestational weeks were （2 407.85±446. 86） g and （2 138.00±445.31 ） g, respectively. The incidence rates of neonatal asphyxia in high birth weight neonates and low birth weight neonates were 2.04% （11/539） and 6.43% （34/529）, respectively. There was statistically significant difference in the incidence rate of neonatal asphyxia between cesarean section group and vaginal delivery group during 32-33＋6 and 28-33＂6 gestational weeks （P〈0. 05） . Among the low birth weight neonates, there was statistically significant difference in the incidence rate of neo- natal asphyxia between cesarean section group and vaginal delivery group during 28-33＋6 gestational weeks （P〈0. 05） . In cesarean section group, there was statistically significant difference in the ineidenee rate of neonatal asphyxia between high birth weight neonates and low birth weight neonates during 34-35＋6 gestational weeks （P〈0. 05） . In vaginal delivery group, there was statistically significant difference in the incidence rate of neonatal asphyxia between high birth weight neonates and low birth weight neonates during 28-31＋6 gestational weeks （exae! probability P=0. 033） . There was statistically significant difference in the incidence rate of neonatal asphyxia between 32-33＋6 gestational weeks and 34-35＋6 gestational weeks （P〈0. 05） . Conclusion Twin pregnancy can be terminated during 32-33＋6 gestational weeks, the incidence rate of neonatal asphyxia in cesarean section group is lower than that in vaginal delivery group, which can improve pregnancy out- come of low birth weight neonates.