高龄孕产妇双胎妊娠母儿结局的临床分析

Clinical analysis of pregnancy and birth outcomes of twin pregnancy in advanced maternal age

目的 分析高龄因素对双胎妊娠母儿结局的影响,探讨孕产期管理经验.方法 选取2014年1月至2018年12月在延安大学附属医院产科诊治的双胎妊娠产妇病例资料,根据孕产妇年龄分为两组:年龄≥35岁者纳入高龄双胎组(n=7637.82±2.39岁);年龄<35岁者纳入对照组(n=21528.31±3.70岁),回顾性比较两组病例妊娠相关资料和母儿结局情况.结果 两组双胎妊娠孕产妇产史、受孕方式和绒毛膜性构成情况比较差异无统计学意义(χ2分别为3.67、3.36、0.78,均P>0.05);两组分娩孕周比较差异无统计学意义(t=1.85,P>0.05),但高龄双胎组足月产率(31.58%)低于对照组(44.65%),差异有统计学意义(χ2=3.96,P=0.04);高龄双胎组子痫前期和GDM发生率均高于对照组(χ2=5.14,P=0.02;χ2=11.68,P<0.01);两组剖宫产、胎盘早剥、前置胎盘、输血、产后出血和子宫切除情况比较差异无统计学意义(χ2值分别为2.79、0.02、0.01、2.22、0.04、2.84,均P>0.05).两组新生儿窒息(χ2=1.65,P>0.05)、出生体重(t=1.27,P=0.35)、病理性黄疸(χ2=1.38,P>0.05)和感染发生率(χ2=0.91,P>0.05)比较差异均无统计学意义.结论 高龄孕产妇双胎妊娠的早产率、子痫前期和GDM发生率更高,但新生儿不良结局指标并无显著差异;应积极开展孕前指导,规范孕产期管理,"个体化"制定分娩计划.

Objective To analyze influence of advanced maternal age(AMA)on pregnancy and birth outcomes of twin pregnancy,and to explore experience of pregnancy and parturition management.Methods The maternal clinical data of twin pregnancy that were diagnozed and treated in Department of Obstetrics,The Affiliated Hospital of Yan’an University from January 2014 to December 2018 were collected.According to age,the parturients were divided into two groups:these parturients aged over 35 years were included in AMA twin group(n=76,37.82±2.39 years old)and those aged less than 35 years were included in control group(n=215,28.31±3.70 years old).The pregnancy-related data and pregnancy and birth outcomes of the parturients in the two groups were compared retrospectively.Results There were no significant differences in maternal history,mode of conception and chorionicity composition between the two groups(χ~2=3.67,3.36 and 0.78 respectively,all P>0.05).Also,there was no significant difference in gestational age at delivery between the two groups(t=1.85,P>0.05),while the full-term birth rate in the AMA twin group(31.58%)was lower than that in the control group(44.65%)(χ~2=3.96,P=0.04),and the incidences of preeclampsia and gestational diabetes mellitus(GDM)in the AMA twin group were higher than those in the control group(χ~2=5.14,P=0.02;χ~2=11.68,P<0.01).There were no significant differences in cesarean section,placental abruption,placenta previa,blood transfusion amount,postpartum hemorrhage and hysterectomy between the two groups(χ~2=2.79,0.02,0.01,2.22,0.04 and 2.84 respectively,all P>0.05).Neonatal outcomes:There were no significant differences in the incidence of neonatal asphyxia,birth weight,pathological jaundice and incidence of infection of the neonates between the two groups(χ~2=1.65,P>0.05;t=1.27,P=0.35;χ~2=1.38,P>0.05;χ~2=0.91,P>0.05).Conclusion The incidences of premature labor,preeclampsia and GDM in twin pregnancy of AMA are higher,but there is no significant difference in adverse neonatal outcomes.We should actively take pregestational guidance,standardize perinatal management,and"individually"formulate the delivery plan for those twin pregnant women.