阴道产及子宫下段剖宫产对双胎妊娠结局的影响

Effect of vaginal delivery and lower uterine cesarean section on twin-pregnancy outcome

目的探究阴道产及子宫下段剖宫产对双胎妊娠结局的影响。方法回顾性分析81例双胎妊娠产妇的临床资料,按照分娩方式的不同分为对照组(阴道产, 40例)和观察组(子宫下段剖宫产,41例)。比较两组产妇的妊娠结局。结果 81例双胎妊娠产妇中,发生率最高的并发症为早产,占比38.27%,发生率最低的并发症为脐带脱垂,占比1.23%,其余并发症包括子痫前期-子痫、贫血、胎膜早破、产后出血、前置胎盘。不同孕周产妇的新生儿窒息率、死亡率比较,差异具有统计学意义(P<0.05)。孕31~33+6周产妇的新生儿窒息率、死亡率最高,孕≥37周产妇的新生儿窒息率、死亡率最低。两组产妇的第一胎窒息率比较,差异无统计学意义(P>0.05);观察组产妇的第二胎窒息率2.44%低于对照组的17.50%,差异具有统计学意义(P<0.05)。两组产妇的产后出血发生率、孕周比较,差异无统计学意义(P>0.05)。观察组新生儿≥2.5 kg占比82.93%高于对照组的68.75%,差异具有统计学意义(P<0.05)。结论双胎妊娠的主要并发症为早产,子宫下段剖宫产使双胎新生儿窒息率降低,妊娠结局改善明显。

Objective To investigate the effect of vaginal delivery and lower uterine cesarean section on twin-pregnancy outcome.Methods A total of 81 cases of twin pregnancy were divided into control group(vaginal delivery,40 cases)and observation group(lower uterine cesarean section,41 cases).The pregnancy outcome of the two groups was compared.Results Among 81 cases of twin-pregnancy women,premature delivery was the highest complication,accounting for 38.27%,and the lowest complication was umbilical cord prolapse,accounting for 1.23%.Other complications included preeclampsia-eclampsia,anemia,premature rupture of membranes,postpartum hemorrhage,and placenta previa.There was no statistically significant difference in neonatal asphyxia rate and mortality of women in different gestational weeks(P<0.05).The neonatal asphyxia rate and mortality of 31-33+6 weeks pregnant women were the highest,and those of≥37 weeks pregnant women were the lowest.There was no statistically significant difference in the asphyxia rate of the first fetus between the two groups(P>0.05);the asphyxia rate of the second fetus in the observation group was 2.44%,which was lower than 17.50%in the control group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in incidence of postoperative hemorrhage and gestational weeks between the two groups(P>0.05).The proportion of newborns≥2.5 kg in the observation group was 82.93%,which was higher than 68.75%in the control group,and the difference was statistically significant(P<0.05).Conclusion The main complication of twin pregnancy is premature delivery.Cesarean section in the lower uterine segment can reduce the neonatal asphyxia rate and improve the pregnancy outcome.