双胎妊娠自发性早产的危险因素分析

Risk factors of spontaneous preterm birth of women with twin pregnancies

目的:探讨双胎妊娠自发性早产的危险因素。方法:回顾性分析2015年6月-2020年6月于本院分娩的双胎妊娠者临床资料,排除胎膜早破、医源性早产者,剔除临床资料不完整者,将剩余双胎妊娠者分为分娩孕周28~36^(+6)周组(早产组,298例)和≥37周组(对照组,1367例),比较两组临床特点,分析引起双胎妊娠自发性早产的危险因素。结果:logistic回归分析显示分娩年龄<25岁(OR=1.691,95%CI 1.108~2.580)、早产史(OR=4.828,95%CI 1.284~18.161)、早孕期保胎史(OR=1.592,95%CI 1.184~2.142)、单绒毛膜性(OR=2.82,95%CI 1.972~4.034)、阴道炎(OR=2.047,95%CI 1.049~3.995)、贫血(OR=2.633,95%CI 1.900~3.648)、宫颈机能不全(OR=5.961,95%CI 2.986~11.901)、子宫畸形(OR=7.843,95%CI 1.323~46.487)、孕期体重增长少[与孕前体重≤55kg相比,孕前体重55~65kg(OR=1.711,95%CI 1.147~2.466)、>65kg(OR=2.31,95%CI 1.356~3.783)及与分娩时体重≤70kg相比,分娩时体重70~85kg(OR=0.373,95%CI 0.254~0.547)、>85kg(OR=0.229,95%CI 0.134~0.392)早产风险降低]是双胎妊娠自发性早产的危险因素。结论:高度重视双胎分娩中年龄<25岁、有早产及早孕期保胎史、单绒毛膜性、阴道炎、贫血、宫颈机能不全、子宫畸形、孕期体重增长少等高危因素,制定个体化干预措施,以改善母婴预后。

Objective:To investigate the risk factors of spontaneous preterm birth of women with twin pregnancies.Methods:The clinical data of the women with twin pregnancies who had delivered in the fourth hospital Shijiazhuang from June 2015 to June 2020 were analyzed retrospectively.The women with preterm premature rupture of membranes,and iatrogenic preterm birth,and incomplete clinical data were excluded from this research.298 women delivered during 28-36^(+6) gestational weeks were included in group A,and 1367 women delivered during≥37 gestational weeks were included in group B.The clinical data of the women were compared between the two groups.The risk factors of spontaneous preterm delivery of the women with twin pregnancies were analyzed.Results:Logistic regression analysis showed that,the age<25 years old at delivery(OR=1.691,95%CI 1.108-2.580),the history of preterm delivery(OR=4.828,95%CI 1.28418.161),the history of early pregnancy(OR=1.592,95%CI 1.284-18.161),the history of preventing miscarriage during the first trimester of pregnancy(OR=1.592,95%CI 1.184-2.142),the monochorionic(OR=2.82,95%CI 1.972-4.034),the vaginitis(OR=2.047,95%CI 1.049-3.995),the anemia(OR=2.633,95%CI 1.900-3.648),the cervical insufficiency(OR=5.961,95%CI 2.986-11.901),the uterine malformation(OR=7.843,95%CI 1.323-46.487)of the women with twin pregnancies were the risk factors of their spontaneous preterm birth.The twin pregnancies women with pre-pregnancy weight 55-65kg had less weight gain during pregnancy than those women with pre-pregnancy weight≤55kg(OR=1.711,95%CI 1.147-2.466),and the women with pre-pregnancy weight>65kg had less weight gain during pregnancy than those women with pre-pregnancy weight≤55kg(OR=2.31,95%CI 1.356-3.783),and which were the risk factors of their spontaneous preterm birth.Compared with those twin pregnancies women with≤70kg at delivery,the women with weight 70-85kg(OR=0.373,95%CI 0.2540.547),and the women with weight>85kg(OR=0.229,95%CI 0.134-0.392)of the women were the risk factors of their spontaneous preterm birth.Conclusion:The age<25 years old,the history of preterm birth,the history of preventing miscarriage during the first trimester of pregnancy,the monochorionic,the vaginitis,the anemia,the cervical insufficiency,the uterine malformation,the less weight gain during pregnancy,and other high-risk factors of the women with twin pregnancies should be paid more attention to,and based on which to formulate the individualized intervention measures,so as to improve the maternal and infant prognosis.