双胎终止妊娠时机及不同分娩方式对围生儿不良结局的影响

The effects of the timing and the different delivery methods on perinatal outcome of twin pregnancy termination

目的探讨双胎不同分娩方式对围生儿不良结局的影响。方法2013年1月至2015年12月在北京妇产医院进行产检并分娩的双胎无并发症病例325例，依据不同分娩方式和孕周（28～31周、32—33周”、34。36周”、37—38周“）分组比较妊娠结局，并分析第一胎为头位的双绒毛膜双胎妊娠结局。结果①双胎剖宫产率占80．62％，剖宫产和阴道分娩的出血率分别是54．58％和26．98％，两组比较，差异有统计学意义，新生儿窒息率在剖宫产和阴道分娩分别为14．12％和15．87％，差异无统计学意义；②在〈32周的病例中，阴道分娩组的新生儿窒息率和围生儿死亡率分别为66．67％和33．33％均高于剖宫产组的15．38％和6．67％，差异有统计学意义；③剖宫产组的产后出血率高于阴道分娩组，差异有统计学意义；④〉32周剖宫产和阴道分娩的双绒毛膜双胎其新生儿窒息及围生儿死亡率均无统计学意义。结论〉32周的双胎阴道分娩不增加围生儿不良妊娠结局；〈32周双胎的分娩方式需要更多研究指导临床。

Objective To investigate the effect of different modes of childbirth on the outcome of twin pregnancy. Methods 325 cases of twins without caxnplications had prenatal care and delivered from January 2013 to December 2015 in Beijing Obstetrics and Gynecology Hospital according to the different mode of delivery and gestational weeks （28～31 weeks, 32～33^＋6 weeks, 34～36^＋6 weeks, 37～38^＋6 weeks）, and the first dichorionic twin pregnancy outcomes were analyzed. Results ① The rate of cesarean section for twins was 80.62%, the bleeding rate of cesarean section and vaginal delivery was 54.58% and 26.98%, respectively. The difference between the two groups was statistically significant, and the rate of neonatal asphyxia was 14.12% and 15.87% respectively in cesarean section and vaginal delivery, and the difference has no statistically significant; ② In the cases of 〈32 weeks of pregnancy, the neonatal asphyxia rate and perinatal mortality rate in the vaginal delivery group were 66.67% and 33.33%, respectively, which were higher than those in the cesarean section group （15.38% and 6.67%, respectively）, and the difference was statistically significant;③ The rate of postpartum hemorrhage in caesarean section was higher than that in vaginal delivery group, and the difference was statistically significant; ④There was no statistical significance in the neonatal asphyxia and perinatal mortality of the first fetal dichoriohic twins, whether cesarean or vaginal delivery 〉 32 weeks of pregnancy. Conclusions For twins 〉 32 weeks of twins, vaginal delivery does not increase the outcome of perinatal undesirable pregnancy; For twins 〈 32 weeks, the mode of childbirth needs more research and guidance.