10年多胎妊娠的变化

Investigation of multiple pregnancies in 10 years

目的 调查上海市 6所医院 10年多胎妊娠情况的变化。方法 选择 1993年 1月～ 2 0 0 2年 12月的多胎妊娠病例 ,对其家族史、病史、妊娠并发症及妊娠结局进行统计学分析。结果 10年中双胎的发生率为0 .6 6 % ,3胎的发生率为 19.0 1∶10 0 0 0 0 ,4胎的发生率为 0 .95∶10 0 0 0 0 ,前、后 5年多胎妊娠发生率的差异无显著性 (P >0 .0 5 )。与前 5年相比 ,后 5年的多胎妊娠中 ,使用辅助生殖技术的比率明显增加 (P <0 .0 0 0 1)。多胎妊娠的并发症以贫血最为多见 ,其次为妊娠高血压综合征、胎膜早破、妊娠肝内胆汁淤积症及产后出血 ,发生率分别为 5 9.0 8%、2 1.94 %、18.2 8%、9.0 0 %和 3.5 2 %。多胎妊娠的早产发生率为 6 5 .2 6 % ,低体重儿发生率为4 8.2 0 % ,围产儿死亡率为 2 7.4 6‰。前 5年围产儿死亡 15例 ,死亡率为 2 3.92‰ ;后 5年围产儿死亡 2 4例 ,死亡率为 30 .2 6‰ ,两者间的差异无显著性 (P =0 .4 7)。分娩方式中 ,剖宫产率为 6 7.6 7% ,其中后 5年较前 5年明显增加 (P =0 .0 4 6 )。结论 上海 10年的多胎妊娠发生率未受辅助生殖技术的影响 ,多胎妊娠的并发症多 ,早产、低体重儿发生率及围产儿死亡率较高 ,剖宫产的增加未能改善围产儿的死亡率。

Objective To survey the changes of multiple pregnancies in 6 hospitals of Shanghai in the past 10 years. Methods Select the case records of multiple pregnancies from 1993 to 2002 and analyze statistically the familial history, complications and outcome. Results The incidence of twin pregnancy was 0.66%, triplet 19.01/100 000, and quadruplet 0.95/100 000. There was no significant difference in the occurance between the late and early 5 years (P>0.05). Assisted reproductive techniques used in multiple pregnancies were more in the early 5 years than that in the late 5 years (P<0.000 1). Among the complications of multiple pregnancies, anemia was most frequent, followed by PIH, PROM, ICP and postpartum hemorrhage with in cidencies of 59.08%, 21.94%, 18.28%, 9.00% and 3.52%, respectively; further more including premature birth of 65.26%, low birth weight 48.20%, and the perinatal mortality was 27.46‰. The frequency of cesarean section was 67.67%, there was significant difference between that in the early 5 years and late 5 years (P<0.05). Conclusions The incidence of multiple pregnancies has not been influenced by assisted reproductive techniques, more complications as premature birth, low birth weight and perinatal mortality occurred in multiple pregnancies. The increase of cesarean section has not decreased the perinatal mortality.