不同绒毛膜性自然受孕双胎围产结局分析

Perinatal outcomes of naturally-conceived twins with different chorionicities

目的:回顾分析自然受孕双胎妊娠相关资料,探讨不同绒毛膜性双胎的围产结局。方法:选取2015年6月至2018年5月于福建医科大学附属福建省妇幼保健院产检和分娩(28周以上)的自然受孕双胎妊娠孕妇,其中单绒毛膜双胎(MCT组)321例,根据年龄、孕前体质量指数(BMI)1∶1对照原则,选取同期双绒毛膜双胎(DCT组)321例,分析两组围产结局的差异。结果:642例双胎孕妇的平均年龄为(29.03±4.53)岁,孕前BMI为(20.73±2.51)kg/m^2,分娩孕周平均为(35.58±2.21)周,新生儿平均出生体重为(2148.89±221.4)g。母、儿围产结局发生前五位的分别为:早产、贫血、胎膜早破、GDM和妊娠期高血压疾病;新生儿高胆红素血症、新生儿畸形、双胎出生体重不一致、小于胎龄儿和新生儿窒息。其中早产的发生率最高,为55.61%。MCT组的早产、<34周早产、脐带帆状附着、双胎出生体重不一致的发生率高于DCT组,但新生儿畸形、新生儿高胆红素血症发生率低于DCT组,差异均有统计学意义(P<0.05)。两组的妊娠期高血压疾病、胎膜早破、贫血、前置胎盘、胎盘早剥、一胎羊水过多、剖宫产率,以及新生儿窒息、小于胎龄儿、围产儿死亡发生率等方面比较,差异均无统计学意义(P>0.05)。结论:单绒毛膜性双胎增加母儿不良妊娠结局的发生率,根据双胎绒毛膜性做好详细的孕期保健,对提高母儿围产结局具有重要意义。

Objective:To retrospectively analyze the information about naturally-conceived twin pregnancies and discuss perinatal outcomes of different chorionicities.Methods:Twin pregnant women delivered in Fujian Provincial Maternity and Children’s Hospital,Affiliated Hospital of Fujian Medical University from June 2015 to May 2018 were involved,who were naturally conceived and had regular antenatal care with gestational weeks were more than 28 weeks.321 monochorionic twin(MCT)and 321 dichorionic twin(DCT)were analyzed to compare their perinatal outcomes.Results:The average maternal age,pregnancy BMI,gestational week,birth weight was(29.03±4.53)year old,(20.73±2.51)kg/m^2,(35.58±2.21)week,(2148.89±221.4)g,respectively.The top five maternal outcomes were preterm birth,anemia,premature rupture of membranes,GDM and hypertensive disorders of pregnancy.The top five fetal outcomes were neonatal hyperbilirubinemia,neonatal malformation,inconsistent birth weight,small for gestational age(SGA)and neonatal asphyxia.The incidence of preterm birth was the highest(55.61%).The incidence of preterm birth,preterm birth less than 34 weeks,cord velamentous insertion,and inconsistent birth weight of MCT were all higher than DCT,and the incidence of neonatal malformation and neonatal hyperbilirubinemia were lower,with statistically significant(P<0.05).But there were no significant differences about the incidence of hypertensive disorders of pregnancy premature rupture of membranes,anemia,placenta previa,placental abruption,polyhydramnios,rates of cesarean section,neonatal prognosis,SGA and perinatal mortality(P>0.05).Conclusion:Monochorionic twin pregnancies may increase the incidence of adverse maternal and fetal outcomes.Good prenatal care should be made to improve the perinatal outcomes according to twin chorionicity.