不同绒毛膜性双胎临床妊娠结局分析

Analysis of clinical pregnancy outcome of different chorionic twins

目的探讨不同绒毛膜性双胎妊娠的临床表现、分娩方式,以及对孕妇及新生儿结局的影响,为早期预防双胎孕妇及新生儿并发症、改善预后提供科学依据。方法回顾性分析2016年1月至2020年12月在石家庄市第四医院住院分娩的双胎妊娠病例3471例,分析不同绒毛膜性双胎孕妇一般情况、受孕方式、母体并发症、分娩方式及围产儿结局,研究不同绒毛性双胎的妊娠结局。结果(1)双绒毛膜性双胎妊娠中初产妇比例(70.72%)高于单绒毛膜性双胎(56.62%),且接近50%受孕方式为辅助生殖技术。(2)妊娠期糖尿病及肝内胆汁淤积症发生率,双绒毛膜性双胎高于单绒毛膜性双胎,其余并发症发生率两者无差异。(3)双绒毛膜性双胎剖宫产终止妊娠比例明显高于单绒毛膜性双胎(83.10%vs.75.45%),但两者产后出血发生率无统计学意义。(4)单绒毛膜性双胎早产发生率(63.47%)明显高于双绒毛膜性双胎早产发生率(47.80%);新生儿出生体重,单绒毛膜性双胎为(2093.00±718.13)g,双绒毛膜性双胎为(2340.25±645.31)g。单绒毛膜性双胎新生儿入住NICU比率明显高于双绒毛膜性双胎(62.98%vs.50.77%)。结论双胎妊娠总的并发症明显高于文献报道的单胎妊娠,尤其单绒毛膜性双胎早产概率明显增高,且对围产儿妊娠结局的影响较双绒毛膜性双胎明显。所以,加强多胎妊娠尤其单绒毛膜性双胎妊娠孕产期管理,建立多胎妊娠管理中心,同时合理应用辅助生殖技术,避免多胎妊娠将是改善母儿结局的重要措施。

Objective To investigate the clinical manifestations and delivery modes of different chorionic twin pregnancies and their effects on the outcomes of pregnant women and newborns,and to provide scientific evidence for the early prevention of complications and improvement of the prognosis of twin pregnancies and newborns.Methods A retrospective analysis was made in 3471 cases of twin pregnancy,who delivered in the Fourth Hospital of Shijiazhuang from January 2016 to December 2020.The general situation,mode of pregnancy,maternal complications,mode of delivery and perinatal outcome of different chorionic twin pregnancy were analyzed,and the pregnancy outcome of different chorionic twins was studied.Results(1)The proportion of primipara with double chorionic twin pregnancy(70.72%)was higher than that with single chorionic twin pregnancy(56.62%),and close to 50%of pregnancies were through assisted reproductive technology.(2)The incidence of gestational diabetes mellitus and intrahepatic cholestasis in double chorionic twins was higher than that in single chorionic twins,but there was no difference in the incidence of other complications.(3)The pregnancy termination rate of double chorionic twins by cesarean section was higher than that of single chorionic twins(83.10%vs.75.45%),but the incidence of postpartum hemorrhage was not statistically different.(4)The incidence of preterm birth in single chorionic twins(63.47%)was significantly higher than that in double chorionic twins(47.80%);The weight of the newborn was(2093.00±718.13)g for single chorionic twins and(2340.25±645.31)g for double chorionic twins.The rate of single chorionic twins admitted to NICU was twins(62.98%vs.50.77%).Conclusions The total incidence of complications of twin pregnancy is significantly higher than that of single pregnancy,especially the rate of premature delivery of single chorionic twins is significantly higher,and the effect on perinatal pregnancy outcome is more significant than that of double chorionic twin pregnancy;therefore,it is very important for the improvement of maternal and neonatal outcome to strengthen the management of multiple pregnancy,especially single chorionic twin pregnancy,to set up the management center of multiple pregnancy,to apply assisted reproductive technology reasonably,and to avoid multiple pregnancy.