单中心5年263例非复杂性双胎妊娠患者的临床分析

Clinical analysis of 263 cases of uncomplicated twin pregnancy in a single center for 5 years

目的探讨我院5年来263例非复杂性双胎妊娠患者的临床特征和新生儿结局情况。方法收集延安大学附属医院产科2013年1月—2017年12月间诊治的非复杂性双胎妊娠患者263例,分为双绒毛膜双羊膜囊(DCDA)组(n=206)和单绒毛膜双羊膜囊(MCDA)组(n=57),比较2组患者一般资料、孕产期主要并发症和新生儿结局情况。结果 DCDA组自然受孕率为69.9%、辅助生殖受孕率为30.1%,与MCDA组(自然受孕率93.0%,辅助生殖率7.0%)比较差异有统计学意义(P<0.05);DCDA组早产者占59.7%(123/206),MCDA组早产者占73.7%(42/57)。DCDA组新生儿不良结局发生率低于MCDA组[36.5%(148/405)vs. 49.1%(55/112),P<0.05];具体比较,DCDA组新生儿窒息发生率[10.1%(41/405)vs. 17.0%(19/112)]和转新生儿重症监护病房(NICU)率[42.0%(170/405)vs. 53.6%(60/112)]低于MCDA组(均P<0.05),而2组新生儿呼吸窘迫综合征(NRDS)、病理性黄疸和感染的发生率差异无统计学意义(均P>0.05)。结论对于非复杂性双胎妊娠患者,应将DCDA和MCDA产妇区别实施规范的孕产期管理,并个体化选择分娩时机。

Objective To investigate the clinical characteristics and neonatal outcomes of 263 cases of uncomplicated twin pregnancy treated in the Affiliated Hospital of Yan＇an University. Methods From January 2013 to December 2017, 263 cases of uncomplicated twin pregnancy were collected and divided into dichorionic diamniotic （DCDA） twin pregnancy group （n=206） and monochorionic diamniotic （MCDA） twin pregnancy group （n=57）. The general data, pregnancy and perinatal complications and neonatal outcomes were compared between the two groups. Results In DCDA group, the natural conception rate was 69.9%, and the assisted reproductive conception rate was 30.1%, which was statistically significant compared with those of MCDA group （93.0% and 7.0%, P 〈 0.05）. There were 123 cases with preterm delivery in DCDA group accounted for 59.7% （123/206）, and 42 cases with preterm delivery （73.7%） in MCDA group. The incidence of neonatal adverse outcomes was 36.5% （148/405） in DCDA group, which was significantly lower than that of 49.1% （55/112） of MCDA group （P 〈 0.05）. The incidence of neonatal asphyxia was significantly lower in DCDA group （10.1%, 41/405） than that in MCDA group （17.0%, 19/112, P 〈 0.05）. Meanwhile, the conversion rate to neonatal intensive care unit （NICU） was significantly lower in the DCDA group （42.0%, 170/405） than that of MCDA group （53.6%, 60/112, P 〈 0.05）. There were no significant differences in the incidence of neonatal respiratory distress syndrome （NRDS）, pathological jaundice and infection between the two groups （P 〉 0.05）. Conclusion For uncomplicated twin pregnancy cases, the standardized pregnancy management should be carried out according to DCDA or MCDA, and the timing of delivery should be individualized.