双胎妊娠早产的临床特点及危险因素分析

Clinical Characteristics of Twin Pregnacy Complicated with Preterm Birth and Analysis of Risk Factors

目的:探讨双胎妊娠早产临床特点及其危险因素。方法:回顾性分析2009年1月1日至2016年12月31日在广州医科大学附属第三医院分娩的2427例双胎妊娠临床资料,将分娩孕周为28~36+6周的双胎妊娠孕产妇及其新生儿作为早产组(1741例),同期分娩孕周为37~40+6周的双胎妊娠孕产妇及其新生儿作为对照组(686例),比较两组病例临床资料特点,分析导致双胎妊娠早产的危险因素。结果:2009~2016年双胎妊娠分娩量呈上升趋势,平均早产率为71.73%。双胎妊娠早产中自发性早产占47%,医源性早产占28%,胎膜早破占25%。早产组平均分娩年龄、体外受精-胚胎移植(IVF-ET)受孕比例、初产妇比例、规律产检比例均较对照组低,差异有统计学意义(P<0.05);既往剖宫产次、当次分娩剖宫产率及子痫前期、胎膜早破、羊水过少、前置胎盘、胎盘植入/粘连、瘢痕子宫比例均较对照组高,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,子痫前期、胎膜早破、羊水过少、前置胎盘及不规律产检是双胎妊娠早产的危险因素(P<0.05)。结论:双胎妊娠早产原因以自发性最多,其次为医源性及胎膜早破。子痫前期、胎膜早破、羊水过少、前置胎盘及不规律产检是双胎妊娠早产的独立危险因素。

Objective:To explore the clinical features and risk factors of premature delivery in twin pregnancies.Methods:This study was a retrospective case-control study,analysis 2427 cases of twin pregnancy and their alive newborns,who delivered in The Third Affiliated Hospital of Guangzhou Medical University of obstetrics and gynecology from January 1,2009 to December 31,2016.1741 cases from 28 weeks to 36+6 weeks as preterm group,meanwhile,another 686 cases from 37 weeks to 40+6 weeks as control group.We compared clinical data of the two groups and analysis the impact factors of preterm birth in twin pregnancies.Results:From 2009 to 2016,the number of twin pregnancies increased,with an average preterm birth rate of 71.73%.Causes of preterm labor in the twin pregnancy were listed at below:spontaneous preterm labor accounted for 47%,iatrogenic preterm labor accounted for 28%,and premature rupture of membranes accounted for 25%.The mean age of childbirth,the proportion of embryo transplantation and conception,primipara,and regular birth inspection in the preterm group were lower than the control group,and the difference was statistically significant(P<0.05).The number of past caesarean section,the proportion of preeclampsia,premature rupture of membranes,insufficient amniotic fluid,preplacental placenta and irregular prenatal examination in the preterm group were higher than the control group(P<0.05).Multivariate Logistic regression analysis showed that preeclampsia,premature rupture of membranes,insufficient amniotic fluid,preplacental placenta and irregular prenatal examination were the independent risk factors for preterm delivery in the twin pregnancies(P<0.05).Conclusions:Spontaneous pretermbirth is the main cause of preterm birth in twin pregnancies.Iatrogenic preterm birth was the second and premature rupture of membranes was the third.Preeclampsia,premature rupture of the membranes,low amniotic fluid,preplacental placenta and irregular prenatal examination are independent risk factors for preterm labor in twin pregnancies.