基于不同绒毛膜性的双胎并发症及结局分析

Analysis of complications and outcomes of twins based on different choriomembranes

目的比较单绒双胎与双绒双胎的并发症及结局,提高对双胎的认识。方法对西北妇女儿童医院产三科2016年度住院的双胎患者资料进行回顾性分析。共有双胎229例,占住院患者总数的3.4%,其中自然受孕108例(47.2%),辅助生殖助孕121例(52.8%)。将165例资料完整的病例按绒毛膜性分类分为单绒毛膜双胎(MC)32例(19.4%),其中单绒双羊30例(18.2%),单绒单羊2例(1.2%);双绒毛膜双胎(DC)133例(80.6%),比较两组的并发症及结局。结果自然受孕组流产率为3.70%,明显低于辅助生殖助孕组的10.74%,差异有统计学意义(P<0.05);单绒双胎的早产率为90.63%,明显高于双绒双胎的72.18%,差异有统计学意义(P<0.05),而在流产率、子痫前期发生率、妊娠期糖尿病发生率、剖宫产率等方面,单绒双胎与双绒双胎比较差异均无统计学意义(P>0.05);其中,孕期发生一胎死亡7例,因早孕期三胎妊娠减胎至双胎者3例,另有3例双胎孕期发现其中一胎畸形,2例于中孕期行氯化钾减胎术,1例于36.7周剖宫分娩。结论辅助生殖助孕双胎流产率显著高于自然受孕率,孕前应详细咨询,单绒双胎较双绒双胎有明显的早产率,孕期应加强监护,改善胎儿结局。

Objective To compare the complications and outcomes of monochorionic twins and dichorionic twins, and to raise the awareness of twins. Methods Retrospective analysis was conducted on the data of pregnant women with twins who were hospitalized in 2016 in the Third Department of Obstetrics and Gynecology in Northwest Women＇s and Children＇s Hospital. The total number of patients with twins was 229, accounting for 3.4% of the total number of inpatients, of which 108（47.2%） were conceived naturally and 121（52.8%） were assisted by ART. According to the chorionic classification, 165 patients with complete data were divided into 32 cases（19.4%） of monochorionic twins（MC）, including 30 cases（18.2%） of monochorionic diamniotic twins and 2 cases（1.2%） of monochorionic monoamniotic twins, and 133 cases（80.6%） of dichorionic twins（DC）. Then the complications and outcomes of two groups were compared. Results The rate of abortion in the spontaneous conception group was 3.70% compared to 10.74% in the ART group, and the difference was statistically significant（P0.05）. The premature birth rate of monochorionic twins was 90.63%, which was significantly higher than 72.18% of dichorionic twins（P0.05）. However, in terms of abortion rate, incidence of preeclampsia, incidence of GDM, and cesarean section rate, there was no statistically significant difference in the comparison of two groups（P0.05）. Among them, 7 cases of one child death occurred during pregnancy, and3 cases of triplets reduced to twins due to early pregnancy. Another 3 cases of twins found one of the fetal malformations during pregnancy, 2 cases were given potassium chloride reduction during pregnancy, and 1 was delivered at 36.7 weeks of cesarean delivery. Conclusion The abortion rate of ART twins is significantly higher than the rate of spontaneous conception, so it should be consulted in detail before pregnancy. There is an apparent preterm birth rate between monochorionic diamniotic twins and dichorionic diamniotic twins, and monitoring should be strengthened during pregnancy to improve fetal outcomes.