双胎妊娠围生儿预后相关因素分析

Related factor analysis of outcome of perinatal fetus with twin pregnancy

目的 探讨双胎妊娠新生儿窒息、围生儿死亡的相关因素。方法 回顾分析 2 5 5例双胎妊娠新生儿Apgar评分、新生儿窒息、围生儿死亡与孕周、新生儿体重、分娩方式的关系。结果 双胎妊娠孕 37～ 39+ 6w组Apgar评分最高、新生儿窒息率最低 ,≥ 2 5 0 0g组Apgar评分最高 ,新生儿窒息率、围生儿死亡率最低。孕周、新生儿体重 4组比较差异均有非常显著性(P <0 0 1)。剖宫产组比阴道分娩组Apgar评分高 ,新生儿窒息率、围生儿死亡率均低 ,2组比较Apgar评分、围生儿死亡率差异无显著性 (P >0 0 5 )。 2组比较新生儿窒息率差异有非常显著性 (P <0 0 1)。结论 双胎妊娠估计每个胎儿体重≥ 2 5 0 0g时 ,宜选择 37～ 39+ 6w终止妊娠为宜。加强孕期、围生期保健 ,积极防治各种并发症 ,适当放宽剖宫产指征 ,避免早产 ,减少低体重儿出生 ,是降低双胎围生儿死亡率、改善其预后的重要措施。

Objective:To study factors related to twin pregnancy neonatal asphyxia and perinatal mortality.Methods:Retrospective analysis was made about the relationship between the neonatal Apgar score of 255 cases of twin pregnancy,neonatalasphyxia,perinatal mortality and the gestational week,neonatal birth weight,presentation sort and delivery mode.Results:The group of twin pregnancy with 37～39 +6 gestational week showed the highest Apgar score and the lowest rate of neonatal asphyxia.The group of birth weight more than or equal to 2500 g showed the highest Apgar score and the lowest rate of neonatal asphyxia and perinatal mortality.There was significant difference for gestational week and neonatal birth weight in 4 groups.The group of vaginal delivery showed the higher Apgar score and the lower rate of neonatal asphyxia and perinatal mortality.There was no significant difference for Apgar score and the rate of perinatal mortality in 2 groups.There was significant difference for neonatal asphyxia rate in 2 groups(P<0.01).Conclusion:Termination of pregnancy is more appropriate for twin pregnancy when gestational weeks are 37～39 +6 and the estimated each fetus birth weight is more than or equal to 2500g.Augument pregnancy health protection and perinatal care,prevention and cure various kinds of complication actively,proper extension of scope of cesarean section,avoidance premature birth,reduction low birth weight infant are the important mesure to decrease the rate of twin perinatal death and amelioration its prognosi.