双胎妊娠孕妇妊娠晚期引产102例临床分析

Clinical analysis of 102 cases of labor induction in the third trimester on twin pregnancy

目的:探讨双胎妊娠孕妇引产的临床特点和引产失败的相关因素。方法:回顾性分析2016年1月至2022年12月在北京大学第三医院引产的双胎妊娠孕妇的临床资料,根据是否临产分为成功组(引产临产者,72例)和失败组(引产未临产者,30例),比较两组孕妇的临床特征差异,采用logistic回归分析双胎妊娠孕妇引产失败的相关因素。结果:失败组双胎妊娠引产孕妇的产次、子宫颈Bishop评分显著低于成功组,而双绒毛膜双羊膜囊双胎占比、辅助生殖技术助孕和子宫颈Bishop评分<6分的比例,产后住院时间、总住院时间均显著高于成功组( P均<0.05)。成功组孕妇人工破膜 ±缩宫素静脉滴注引产的比例为72.2%(52/72),显著高于失败组(46.7%,14/30;P=0.030)。成功组与失败组孕妇的分娩孕周,严重产后出血、输血的发生率,产后出血量、两胎儿的新生儿出生体重、新生儿窒息的发生率、新生儿入住新生儿重症监护病房的比例分别比较,差异均无统计学意义( P均>0.05)。所有引产孕妇均无严重会阴裂伤、均未切除子宫。多因素logistic回归分析结果显示,初产妇( OR=3.064,95% CI为1.112~8.443;P=0.030)和子宫颈Bishop评分<6分( OR=5.208,95% CI为2.008~13.508;P=0.001)是影响双胎妊娠孕妇引产失败的独立危险因素。 结论:双胎妊娠孕妇择期引产是安全可行的;严格把握终止妊娠时机和指征,根据子宫颈条件选择合适的引产方法,积极促使子宫颈成熟,有利于提高引产成功率。

ObjectiveTo investigate the clinical characteristics of induced labor in twin pregnancy and the related factors of induced labor failure.MethodsThe clinical data of twin pregnant women who underwent induced labor in Peking University Third Hospital from January 2016 to December 2022 were retrospectively analyzed.According to whether they had labor or not after induction,pregnant women were divided into the success group(pregnant women who had labor after induction,72 cases)and the failure group(pregnant women who did not have labor after induction,30 cases).Logistic regression was used to analyze the related factors of induction failure in twin pregnant women.ResultsThe parity and cervical Bishop score in the failure group were significantly lower than those in the success group,while the proportion of dichorionic diamniotic twins,assisted reproductive technology pregnancy and cervical Bishop score<6,postpartum hospital stay and total hospital stay in the failure group were significantly higher than those in the success group(all P<0.05).The proportion of induced labor by artificial rupture of membranes±oxytocin intravenous infusion in the success group was 72.2%(52/72),which was significantly higher than that in the failure group(46.7%,14/30;P=0.030).There were no significant differences between the two groups in the gestational age at delivery,the incidence of severe postpartum hemorrhage and blood transfusion,the amount of postpartum hemorrhage,the neonatal weight of two fetuses,the incidence of neonatal asphyxia,and the proportion of neonates admitted to the neonatal intensive care unit(all P>0.05).There were no severe perineal laceration and hysterectomy in all pregnant women.Multivariate logistic regression analysis showed that primipara(OR=3.064,95%CI:1.112-8.443;P=0.030)and cervical Bishop score<6(OR=5.208,95%CI:2.008-13.508;P=0.001)were the independent risk factors for induction failure in twin pregnancy.ConclusionsElective induction of labor in twin pregnancy is safe and feasible.It is helpful to improve the success rate of induction of labor by strictly grasping the timing and indications of termination of pregnancy,choosing the appropriate method of induction according to the condition of the cervix,and actively promoting cervical ripening.