不同绒毛膜性双胎新生儿不良围产结局的检出率及影响因素

Detection rate of adverse perinatal outcomes in different chorionic twin neonates and factors

目的探讨不同绒毛膜性双胎新生儿不良围产结局的检出率及影响因素。方法选取双胎妊娠产妇420例,根据绒毛膜性分为单绒毛膜组(MC组,n=116)和双绒毛膜组(DC组,n=304),比较2组产妇所产双胎新生儿不良围产结局[至少1个活产儿出现1种及以上情况:小于胎龄儿(SGA)、1 min Apgar评分低于7分、新生儿缺血缺氧性脑病(HIE)、新生儿呼吸窘迫综合征(NRDS)及新生儿死亡]和良好结局的发生情况;收集所有双胎新生儿临床资料(母亲年龄、是否初产、母体是否有产科并发症、母体是否有慢性疾病、是否胎膜早破、羊水量是否异常、脐血流是否异常、是否早产、分娩孕周、分娩方式、小儿与大儿体质量及体质量不一致性),分别采用单因素分析法和多因素logistic回归分析法分析MC组和DC组双胎妊娠产妇所产新生儿不良围产结局的影响因素。结果MC组双胎妊娠产妇所产新生儿不良围产结局的检出率(56.03%)高于DC组(44.74%),差异有统计学意义(χ^(2)=4.295,P=0.038);多因素logistic回归分析结果显示,非初产、脐血流异常、早产及双胎体质量不一致性≥20%为MC组双胎妊娠产妇所产新生儿不良围产结局的独立危险因素(OR=2.565、2.980、2.804、4.080,P<0.05),母体有产科并发症、早产、分娩方式为阴道分娩及双胎体质量不一致性≥20%为DC组双胎妊娠产妇所产新生儿不良围产结局的独立危险因素(OR=2.635、2.447、2.787、2.659,P<0.05)。结论与DC组比较,MC组双胎妊娠产妇双胎新生儿不良围产结局的检出率较高,且与初产、脐血流、早产及双胎体质量不一致性有关;DC双胎新生儿不良围产结局的发生则与母体产科并发症、早产、分娩方式及双胎体质量不一致性有关。

Objective To investigate detection rate and factors of adverse perinatal outcomes in different chorionic twin neonates.Methods A total of 420 pregnant women with twin pregnancies were selected and divided into single chorionic(MC)group(n=116)and the double chorionic(DC)group(n=304);adverse perinatal outcomes[at least one live birth with at least one or more following conditions:small for gestational age(SGA),1 min Apgar score lower than 7,hypoxic ischemic encephalopathy(HIE),neonatal respiratory distress syndrome(NRDS),and neonatal death]and good outcomes of twin neonates were collected and compared between both groups.Collecting all twins neonatal clinical data(including the mother’s age,first-delivery or not,maternal obstetric complications or not,maternal chronic disease or not,premature rupture of membranes or not,abnormal amniotic fluid or not,abnormal umbilical blood flow or not,preterm birth or not,gestational age,mode of delivery,small neonate’s body mass,big neonate’s body mass,and inconsistency of body mass).Univariate analysis and multivariate logistic regression analysis were used respectively to analyze the related factors of adverse perinatal outcomes of twin neonates from pregnant women in both groups.Results The positive rate of adverse perinatal outcome in neonates born in MC group with twin pregnancies(56.03%)was higher than that of DC group(44.74%),and the difference was statistically significant(χ^(2)=4.295,P=0.038).Multivariate logistic regression analysis showed that non-first delivery,abnormal umbilical blood flow,premature delivery and body mass inconsistency≥20%were independent risk factors for poor perinatal outcome of women with twin pregnancies in MC group(OR=2.565,2.980,2.804,4.080;P<0.05).Maternal obstetric complications,premature delivery,vaginal delivery and body mass inconsistency≥20%were independent risk factors for poor perinatal outcome of neonates in women with twin pregnancies of DC group(OR=2.635,2.447,2.787,2.659;P<0.05).Conclusion The positive rate of adverse perinatal outcomes of MC twin-pregnancies women is higher compared with that of MC group,and the results is related to first delivery,umbilical blood flow,premature delivery and twins’body mass inconsistency;while the occurrence of adverse perinatal outcomes of DC twins is related to maternal obstetric complications,premature delivery,delivery mode,and body mass inconsistency.