妊娠高血压疾病对双胎妊娠早产儿结局的影响

Effect of hypertensive disorders of pregnancy on outcomes of twin-premature infants

目的调查妊娠高血压疾病对双胎妊娠早产儿结局的影响。方法回顾性分析2010年1月至2018年12月复旦大学附属妇产科医院分娩的胎龄为28~36+6周双胎儿的临床资料。结果本研究共纳入1299对双胎儿,其中妊高症组332对,非妊高症组967对,双胎妊娠合并高血压疾病发生率为25.56%,两组产妇年龄差异无统计学意义(P>0.05)。妊高症组产妇剖宫产率、试管婴儿(IVF)率及双绒毛膜双胎比例显著高于非妊高症组(97.6%vs94.3%,χ^(2)=5.755,P=0.016;49.1%vs 39.1%,χ^(2)=10.183,P=0.001;74.4%vs 67.2%,χ^(2)=9.253,P=0.010)。妊高症组产妇妊娠合并低蛋白血症发生率、胎儿生长受限(FGR)发生率显著高于非妊高症组产妇(5.7%vs 0.6%,χ^(2)=34.089,P<0.001;8.1%vs 4.7%,χ^(2)=5.713,P=0.017),低出生体重儿发生率、新生儿低血糖发生率、红细胞增多症发生率均显著高于非妊高症组(25.6%vs16.2%,χ^(2)=28.970,P<0.001;7.7%vs4.1%,χ^(2)=13.446,P<0.001;5.7%vs3.8%,χ^(2)=4.588,P=0.032),Logistic回归分析发现妊娠高血压疾病对新生儿呼吸窘迫症(NRDS)的影响无统计学意义(P=0.872)。结论双胎妊娠合并高血压疾病会增加产妇及围生儿的不良预后。在临床工作中,可针对相关产妇及双胎儿采取积极干预措施,减少其对不良结局的影响。

Objective To investigate the influence of hypertensive disorders of pregnancy on the outcomes of twin-premature infants.Methods A retrospective study was performed to analyze the clinical data of twin fetuses with gestational age of 28-36+6 weeks delivered in Obstetrics&Gynecology Hospital of Fudan University from January 2010 to December 2018.Results A total of 1299 pairs twins were included in this study.332 pairs were induced in hypertension group and 967 pairs were in the non-hypertension group.The incidence of hypertensive disorders of twin pregnancy was 25.56%.And there was no significance among them about age(P>0.05).The cesarean section rate,the rates of in vitro fertilization(IVF)and dichorionic twins were significantly higher than those in the non-hypertension group(97.6%vs 94.3%,χ^(2)=5.755,P=0.016;49.1%vs 39.1%,χ^(2)=10.183,P=0.001;74.4%vs 67.2%,χ^(2)=9.253,P=0.010).The incidence of pregnancy combined with hypoproteinemia and fetal growth restriction(FGR)were significantly higher in the hypertension group than the control group(5.7%vs 0.6%,χ^(2)=34.089,P<0.001;8.1%vs 4.7%,χ^(2)=5.713,P=0.017).The incidence of low-birth-weight infants,neonatal hypoglycemia and polycythemia were significantly higher than those in the control group(25.6%vs 16.2%,χ^(2)=28.970,P<0.001;7.7%vs 4.1%,χ^(2)=13.446,P<0.001;5.7%vs 3.8%,χ^(2)=4.588,P=0.0320).Logistic regressive analysis showed that there was no significant difference in the incidence of neonatal respiratory distress(NRDS)(P=0.872).Conclusion Twin pregnancy combined with hypertensive disorders can increase the adverse outcomes of maternal and perinatal infants.Positive intervention measures can be taken for related maternal and perinatal infants to reduce the adverse outcomes in clinical work.