双胎生长不一致对妊娠结局的影响

Effect of inconsistent twin growth on pregnancy outcome

目的探讨双胎生长不一致对妊娠结局的影响。方法回顾性分析2020年1月―2021年9月在济宁医学院附属医院产科分娩的双胎妊娠424例,根据双胎出生体重差(BWD)分为不一致组(BWD≥20%)和一致组(BWD<20%),比较两组妊娠结局的差异,分析双胎生长不一致对妊娠结局的影响。结果与一致组比较,不一致组妊娠期高血压疾病(33.3%vs 15.1%)、脐带帆状附着(11.1%vs 4.3%)、低出生体重(59.3%vs 41.5%)、小于胎龄儿(38.0%vs 12.4%)和新生儿监护病房住院(69.4%vs 51.8%)的比例均提高(P<0.05)。双绒毛膜(dichorionic,DC)双胎妊娠期高血压疾病(OR=2.6,95%CI:1.3~5.3)、低出生体重(OR=2.2,95%CI:1.4~3.5)、新生儿监护病房住院(OR=2.0,95%CI:1.3~3.2)的发生风险不一致组均高于一致组(P<0.05);单绒毛膜(monochorionic,MC)双胎脐带帆状附着的发生风险不一致组高于一致组(OR=6.0,95%CI:1.4~25.8);MC双胎和DC小于胎龄儿的发生风险不一致组均高于一致组(OR=7.1,95%CI:2.5~20.4;OR=3.9,95%CI:2.4~6.4,P<0.05)。结论双胎生长不一致与妊娠结局密切相关,增加了新生儿并发症的风险性。在临床工作中,应早期识别高危因素,预防妊娠期高血压疾病,加强孕期管理,进而改善妊娠结局。

Objective To investigate the effect of inconsistent twin growth on pregnancy outcome.Methods Retrospectively analyzed 424 twin pregnancies delivered in the obstetrics department of the hospitalfrom January 2020 to September 2021,the twinsweredivided into inconsistent group(BWD≥20%)and consistent group(BWD<20%)according to the birth weight discordance(BWD)of the twins,the researchcompared the differences in pregnancy outcomes between the two groupsand analyzed the effect of inconsistent growth of the twins on pregnancy outcomes.Results The inconsistent group had hypertensive disorders in pregnancy(33.3%vs 15.1%),umbilical cord sail attachment(11.1%vs 4.3%),low birth weight(59.3%vs 41.5%),small for gestational age(38.0%vs 12.4%)and neonatal care unit admissions(69.4%vs 51.8%)were higher than the consistent group(P<0.05).Univari-ate regression analysis grouped by chorionicity showed that hypertensive disorders in pregnancy in the dichorionic twin group(OR=2.6,95%CI:1.3~5.3),low birth weight(OR=2.2,95%CI:1.4~3.5),intensive care(OR=2.0,95%CI:1.3~3.2)had a higher risk of occurrence in the inconsistent group than the consistent group(P<0.05);The risk of umbilical cordsail attachment in monochorionic twins was higher in discordant group than in concordant group(OR=6.0,95%CI:1.4~25.8);the risk of occurrence of small for gestational age was higher in the inconsistent group than in the consistent group in both the monochorionic and bichorionic tiwn groups(OR=7.1,95%CI:2.5~20.4;OR=3.9,95%CI:2.4~6.4,P<0.05).Conclusions Inconsistent growth of twin fetuses are closely associated with pregnancy outcome and increase the risk of neonatal complications.In clinical fieldwork,early identification of high-risk factors,prevention of hypertensive disorders in pregnancy,and better management of pregnancy should be performedfor improving pregnancy outcomes.