双胎妊娠阴道试产脐动脉血气差异分析及相关因素

Analysis of the differential blood gas of the umbilical artery of the twin of pregnant women during the trial vaginal delivery and its correlative factors

目的:探讨双胎妊娠阴道试产时两胎脐动脉血气的差异及相关因素。方法:回顾性分析2021年12月-2024年1月在本院进行阴道试产的双胎妊娠孕妇36例临床资料,分析临床特性、脐动脉血气结果及新生儿结局,探讨两胎脐动脉血气指标差异的相关因素。结果:脐动脉血气分析,第2胎脐动脉血气PH(7.22±0.10)、碱剩余(-4.48±3.29 mmol/L)均低于第1胎(7.29±0.06、-3.10±3.27 mmol/L),乳酸(3.68±1.52 mmol/L)高于第1胎(3.00±1.15 mmol/L)。两胎血气指标差异与产妇年龄、分娩前胎位、绒毛膜性、分娩孕周、发动方式、引产方式、产程中缩宫素使用、产程中胎心监测、分娩结局、分娩胎位等均不相关,与新生儿是否住院、住院时长不相关;双胎血气PH差异与是否为初产妇及BMI值存在中度相关,与新生儿出生后1min Apgar评分、5min Apgar评分存在中度相关。结论:本研究提示双胎阴道试产中,第2胎具有相对较差脐动脉血气状态,第二胎发生急性产时缺氧风险升高,但合适的病例在规范产程管理情况下,并不增加新生儿不良结局。

Objective:To explore the differential blood gas of the umbilical artery of the twin of pregnant women during the trial vaginal delivery,and to study its correlative factors.Methods:A retrospective analysis was conducted on the clinical data of 36 pregnant women with twin pregnancies who had been trial vaginal delivery from December 2021 to January 2024.The clinical characteristics,the umbilical artery blood gas results and the neonatal outcomes of the women were analyzed,and the relevant factors of the differences of the umbilical artery blood gas indicators between the two fetuses were explored.Results:The results of umbilical artery blood gas analysis indicated that the values of pH(7.22±0.10)and alkaline residue(4.48±3.29 mmol/L)of umbilical artery blood gas of the second fetus were significantly lower than those(7.29±0.06 and 3.10±3.27 mmol/L)of the first fetus,but the lactate level(3.68±1.52mmol/L)of umbilical artery blood of the second fetus was significantly higher than that(3.00±1.15 mmol/L)of the first fetus.The differences of the blood gas indexes of the two fetuses had no correlation with the maternal age,the fetal position before delivery,the chorionic nature,the gestational weeks at delivery,the mode of initiation of labor,the mode of induction,the oxytocin used and the fetal heart rate monitoring during labor,the delivery outcomes,the fetal position at delivery,the whether the neonates transferred to hospital,but which had moderately correlation with the primiparas rate and the BMI of the women,and the neonatal Apgar score at 1min and 5min after birth.Conclusion:This study suggests that during the trial vaginal delivery of the pregnant women with twins,the second fetus of the women has the relatively poor umbilical artery blood gas status,which indicating that the second fetus has the increased risk of acute hypoxia during labor.However,the pregnant women with twins are given standardized labor management,which do not increase their adverse neonatal outcomes in clinical practice.