双胎妊娠阴道试产孕妇的临床特征及其试产失败的相关因素分析

Clinical features of vaginal trial delivery in twin pregnancy and factors related with failure

目的探讨双胎妊娠阴道试产孕妇的临床特征及其试产失败的相关因素。方法连续性纳入2016年1月至2021年6月在北京大学第三医院阴道试产的双胎妊娠孕妇,共137例,获取其临床资料,根据是否阴道试产将其分为阴道试产成功组(双胎均阴道分娩,109例),阴道试产失败组(双胎之一或全部转为剖宫产分娩,28例),比较两组孕妇临床特征差异,分析双胎妊娠阴道试产失败的相关因素。结果双胎妊娠阴道试产成功组和失败组孕妇年龄分别为(32.4±3.8)和(31.3±3.3)岁(P=0.163)。成功组孕妇辅助生育技术受孕的比例、引产的比例分别为36.7%(40例)和35.8%(39例),均低于失败组,失败组均为60.7%(17例)(均P<0.05);成功组孕妇分娩孕周、胎儿1体重、胎儿2体重、双胎体重之和分别为(35.5±1.9)周、(2 328.4±431.9)g、(2 286.2±434.8)g、(4 614.6±801.9)g,均小于失败组,分别为(36.7±2.1)周、(2 585.7±443.9)g、(2 531.8±574.8)g、(5 117.5±916.1)g(均P<0.05)。多因素分析结果显示,辅助生育技术受孕(OR=2.878,95%CI:1.167~7.099)、双胎体重之和≥4 735 g(OR=4.304,95%CI:1.659~11.165)是双胎妊娠阴道试产失败的相关因素。结论双胎妊娠阴道试产相对安全。辅助生育技术受孕、双胎体重之和≥4 735 g的双胎妊娠孕妇选择阴道分娩应慎重。

Objective To investigate the case characteristics and factors related with failure of vaginal trial delivery in twin pregnancy.Methods A retrospective analysis was performed on the clinical data of patients with twin pregnancy who underwent vaginal trial delivery in Peking University Third Hospital from January 2016 to June 2021.There were 109 cases in the successful group(vaginal delivery of both fetuses)and 28 cases in the failed group(cesarean delivery of one or all fetuses),the differences between the two groups were compared and the related factors of vaginal trial failure in twin pregnancy were analyzed.Results There was no significant difference in age between the two groups[(32.4±3.8)years vs(31.3±3.3)years,P=0.163].The proportion of conception through assisted reproductive technology and induced labor in the successful group was significantly lower than that in the failed group(36.7%vs 60.7%,P<0.05;35.8%vs 60.7%,P<0.05).The average gestational age[(35.5±1.9)weeks vs(36.7±2.1)weeks,P<0.05],the body weight of the first fetus[(2328.4±431.9)g vs(2585.7±443.9)g,P<0.05],the body weight of the second fetus[(2286.2±434.8)g vs(2531.8±574.8)g,P<0.05]and the sum of the body weight of the two fetuses[(4614.6±801.9)g vs(5117.5±916.1)g,P<0.05]in the successful group were significantly lower than those of the failure group.Multivariate analysis showed that assisted fertility technique(OR=2.878,95%CI:1.167-7.099)and the sum of the body weight of the two fetus≥4735g(OR=4.304,95%CI:1.659-11.165)were independent risk factors for vaginal trial failure of twin pregnancy.Conclusions Vaginal trial delivery in twin pregnancy is relatively safe.Vaginal delivery should be carefully selected for patients with twin pregnancy who concepted through assisted reproductive technology and the sum of the body weight of the two fetus≥4735g.