单绒毛膜双胎妊娠母儿结局的临床分析

Maternal and neonatal outcomes in monochorionic diamniotic twin pregnancy

目的 全面分析单绒毛膜双羊膜囊(MCDA)双胎妊娠对孕母、胎儿及新生儿并发症的影响。方法选取青岛大学附属医院2016年1月—2017年6月收治的MCDA孕产妇123例为MCDA组,同期收治的双绒毛膜双羊膜囊(DCDA)孕产妇325例为DCDA组。分析比较两组孕产妇、胎儿、新生儿的并发症情况。结果 MCDA组产妇早产、妊娠期肝内胆汁淤积、羊水过多、胎膜早破发生率明显高于DCDA组(χ^(2)=4.595~10.715,P<0.05);MCDA组胎儿死亡率及脐血流异常、胎儿窘迫发生率明显高于DCDA组(χ^(2)=4.852~11.656,P<0.05);MCDA组新生儿入住NICU、脑损伤、先天性心脏病、高胆红素血症、低糖血症发生率明显高于DCDA组(χ^(2)=5.181~12.285,P<0.05)。结论 MCDA双胎妊娠围生期母婴并发症发生率明显高于DCDA双胎妊娠,临床工作中应加强对MCDA双胎妊娠围生期母婴管理及监护。

Objective To investigate the influence of monochorionic diamniotic(MCDA)twin pregnancy on complications in pregnant women,fetuses,and neonates.Methods A total of 123 women with MCDA pregnancy who were admitted to The Affiliated Hospital of Qingdao University from January 2016 to June 2017 were enrolled as MCDA group,and 325 women with dichorionic diamniotic(DCDA)pregnancy were enrolled as DCDA group.The two groups were analyzed and compared in terms of the complications in pregnant and parturient women,fetuses,and neonates.Results Compared with the DCDA group,the MCDA group had significantly higher incidence rates of premature delivery,intrahepatic cholestasis of pregnancy,polyhydramnios,and premature rupture of membrane(χ^(2)=4.595-10.715,P<0.05).As for the complications in fetuses,the MCDA group had significantly higher mortality rate and incidence rates of umbilical blood flow abnormalities and fetal distress than the DCDA group(χ^(2)=4.852-11.656,P<0.05).As for the complications in neonates,compared with the DCDA group,the MCDA group had a significantly higher rate of admission to the neonatal intensive care unit and significantly higher incidence rates of neonatal brain injury,congenital heart disease,neonatal hyperbilirubinemia,and neonatal hypoglycemia(χ^(2)=5.181-12.285,P<0.05).Conclusion MCDA twin pregnancy has a higher incidence rate of perinatal complications in mothers and infants than DCDA twin pregnancy,and perinatal management and monitoring should be strengthened for mothers and infants in MCDA twin pregnancy.