不同分娩方式对双胎妊娠结局的影响及相关危险因素分析

Effect of vaginal delivery and cesarean section on twin pregnancy outcomes and pregnancy associated risk factors

目的分析阴道分娩和剖宫产两种分娩方式对双胎妊娠结局的影响及妊娠相关危险因素。方法回顾性分析2014年1月至2016年6月上海市宝山区罗店医院收治的86例双胎妊娠产妇的临床资料,根据分娩方式的不同分为研究组和对照组,研究组54例均为子宫下段剖宫产,对照组32例均为阴道分娩,分析双胎妊娠孕妇的并发症发生率,同时对两组孕妇的产后出血发生率、孕周及新生儿的死亡率和窒息率进行比较,并对结果进行统计学分析。结果早产是双胎妊娠产妇中发生最高的并发症(38.37%),其次为子痫前期-子痫(16.28%),脐带脱垂的发生率最低(1.16%);孕31~33+6周的新生儿的窒息率和死亡率均最高,其余依次为孕34~36+6周和孕周≥37周,差异均有统计学意义(χ~2值分别为11.04、15.47,均P<0.01);两组双胎新生儿中,对照组第二胎新生儿的窒息率均显著高于该组第一胎及研究组的第二胎的窒息率(χ~2值分别为5.38、6.72,均P<0.05),研究组新生儿体重≥2.5kg的例数明显高于对照组,差异存在统计学意义(χ~2=4.34,P<0.05)。结论早产是双胎妊娠的主要危险因素,子宫下段剖宫产能显著降低双胎新生儿的窒息率,有利于改善双胎妊娠产妇及新生儿的结局,值得在临床进一步推广。

Objective To analyze the effect of vaginal delivery and associated risk factors. Methods Clinical data of 86 parturients with cesarean section on twin pregnancy outcomes and pregnancy twin pregnancy was retrospectively analyzed, and according to different methods of delivery they were divided into research group and control group. Fifty-four cases in the research group were treated with lower segment cesarean section, while 32 cases in the control group underwent vaginal delivery. Incidence of complication in twin pregnancy women was analyzed. At the same time, incidence of postpartum hemorrhage, gestational age, neonatal mortality and asphyxia rate in two groups were compared, and results were statistically analyzed. Results Preterm birth was the complication with highest incidence in twin pregnancy women （38.37 %）, followed by preeclampsia-eclampsia （16.28%）, and incidence of umbilical cord prolapse was lowest （1.16%）. Neonatal asphyxia rate and mortality rate at 31-33^＋6 weeks of pregnancy were highest, followed by ≥37weeks and 34-36^＋6 weeks, and differences were statistically significant （χ^2 value was 11.04 and 15.47, respectively, both P〈0.01）. Among newborns in two groups, neonatal asphyxia rate in the second fetus in the control group was significantly higher than that in the first fetus in same group and the second fetus in the research group （χ^2 value was 5.38 and 6.72, respectively, both P〈0.05）, and number of neonates with weight ≥2.5Kg in the research group was notably higher than that in the control group with significant difference （χ^2 =4.34, P〈0.05）. Conclusion Preterm birth is major risk factor for twin pregnancy. Lower uterine segment cesarean section can significantly reduce asphyxia rate in twin neonates, and improve maternal and neonatal outcomes in twin pregnancies, so it is worthy of further clinical popularization.