不同绒毛膜性双胎围产结局717例临床分析

The Impact of Chorionicity on the Perinatal Outcome in Twin Pregnancies-A Retrospective Analysis of 717 Cases

目的:探讨不同绒毛膜性双胎围产结局,为临床诊疗工作和后续科学研究的开展奠定基础,明确重点方向。方法:回顾性分析2008年1月至2017年3月在西安交通大学第一附属医院产科住院分娩的双胎妊娠病例共717例,其中单绒毛膜双胎206例(单绒毛膜组),双绒毛膜双胎511例(双绒毛膜组)。对两组的基本情况、母体结局和围产儿结局进行比较,并采用非条件Logistic逐步回归模型进行绒毛膜性对双胎不良围产结局影响的多因素分析。结果:①提供不同绒毛膜性双胎终止妊娠孕周和出生体质量的分布情况图,单绒毛膜组中在孕28~36+6周终止妊娠的占67.96%,双绒毛膜组中占58.51%。单绒毛膜组中大儿体质量集中在2000~3000 g占72.78%,小儿体质量集中在1500~2500 g占65.68%;双绒毛膜组中分别占70.27%和64.66%。②不同绒毛膜性双胎的母体并发症发生率差异均无统计学意义(P>0.05),与双绒毛膜组比较,单绒毛膜组自发性早产率较高、入院孕周、终止妊娠孕周均较早,差异均有统计学意义(P<0.05)。③单绒毛膜性是发生双胎之一死亡(OR 2.82,95%CI 1.41~5.64)、体质量不一致性≥25%(OR 2.00,95%CI 1.19~3.37)以及极低或超低体质量儿(OR 2.40,95%CI 1.26~4.59)的独立危险因素(P<0.05)。结论:相比于母体结局,绒毛膜性对围产儿结局的影响更大,单绒毛膜性是双胎不良围产儿结局的危险因素,临床管理中应重视对绒毛膜性的判定以及对单绒毛膜双胎围产期的监测,以尽可能改善单绒毛膜双胎的围产结局。

Objective:The study aimed to assess the perinatal outcome in relation to chorionicity in twin pregnancies,laying the foundation for clinical diagnosis and follow-up scientific research,and defining the key directions.Methods:A retrospective analysis of 717 cases of twin pregnancy was conducted,including 206 monochorionic twins(monochorionic group),511 dichorionic twins(dichorionic group).The basic situation,maternal outcome and perinatal outcome of the two groups were compared,and the unconditional logistic stepwise regression model was used to analyze the impact of the chorionicity on adverse perinatal outcomes of twin births.Results:①In the monochorionic twins group,67.96%of pregnancies were terminated at 28-36+6 weeks,and 58.51%in the dichorionic twins group were terminated at 28-36+6 weeks.In the monochorionic twins,72.78%of the larger twins′birth weight ranged from 2000 to 3000 g,65.68%of the smaller twins′birth weight ranged from 1500 to 2500 g.The corresponding percentage of dichorionic twins group was 70.27%and 64.66%respectively.②The rates of maternal complications between the two groups showed no significant differences(P>0.05).Compared with dichorionic twins group,the single chorionic group had a higher rate of spontaneous preterm birth,earlier weeks of admission to hospital and earlier weeks of termination of pregnancy(P<0.05).③Monochorionicity was an independent risk factor for single intrauterine death(OR 2.82,95%CI 1.41-5.64),weight discordance≥25%(OR 2.00,95%CI 1.19-3.37),and very low or extremely low birth weight(OR 2.40,95%CI 1.26-4.59).Conclusions:Compared with maternal outcomes,chorionicity had a greater impact on perinatal outcomes.Monochorionicity was a risk factor for poor perinatal outcomes in twins.Weshould pay attention to the determination of chorionicity and the monitoring of monochorionic twin pregnancy in clinical management,to improve its perinatal outcome.