双胎胎儿生长不一致妊娠结局的探讨分析

+王佳蓉

【摘要】目的分析探讨双胎胎儿生长不一致的妊娠结局。方法回顾性分析双胎妊娠产妇24例的临床资料。以双胎胎儿体重差>20%为诊断标准, 分为观察组14例和对照组10例(发育一致性), 比较两组间孕妇的一般情况。结果观察组并发围生儿死亡率明显高于对照组(P<0.05)；观察组剖宫产分娩12例(85.7%), 对照组剖宫产分娩8例(80.0%), 两组比较差异无统计学意义(P>0.05)；观察组新生儿入住NICU比率明显高于对照组, 两组比较差异有统计学意义(P<0.05)。观察组并发症发生率高于对照组(P<0.05)。结论发育不一致性双胎妊娠并发症及围生儿患病率和死亡率明显高于发育一致性双胎, 及早发现和处理双胎发育不一致, 是改善胎儿和新生儿预后的关键。

【关键词】胎儿发育；生长不一致；妊娠结局；分析

Clinical observation on perinatal outcome in discordant twin pregnancies WANG Jia-rong. Department of Obstetrics, Dafeng Hospital of Chaoyang District, Shantou 515100, China

【Abstract】ObjectiveTo analyze the perinatal outcomes of growth discordant in twins pregnancy.MethodsA retrospective analysis of clinical data was conducted in 24 cases of twin babies who were admitted in our hospital from January 2011 to January 2014,and the 24 cases were divided groups：observation group(14 cases) and control group(10 cases). Twin pairs whose birth weight difference was 20% or more were designated as discordant twins. To compare the difference between of the pairs. ResultsThe perinatal mortality in observation group was significantly higher than that in control group(P<0.05)；Cesarean section delivery was 12 cases and 8 cases in observation group and control group, accounted 85.7% and 80.0%, there was no significant difference in the two groups(P>0.05). Neonatal occupancy rate in NICU and complication rate were obviously higher in observation group than that in the control group, and there was significant difference(P<0.05). ConclusionThe mortality is higher in developmental nonidentity twins, early detection and management of twin developmental inconsistency, and it is the key to improve fetal and neonatal prognosis.

【Key words】Fetal development; Growth discordant; Pregnancy outcome; Analysis双胎妊娠属于高危妊娠中常见的一种, 其围生儿病死率较单胎可高出3~7 倍［1］。双胎的不一致性(twin discordancy)是指双胎在生长发育、基因型的表型中的不一致。本文回顾2011年1月~2014年1月本院双胎妊娠病例资料, 现报告如下。

1资料与方法

1. 1一般资料本组双胎妊娠孕产妇24例, 年龄24~46岁, 平均年龄为32.2 岁, 孕周在33+1~39+1周, 均为初产妇, 其中合并并发症5例, 包括子痫前期2例, 胎膜早破2例, 前置胎盘1 例, 以双胎胎儿间体质量差>20%为诊断标准［2-4］, 将24例孕产妇分为观察组14例(发育不一致性双胎妊娠)和对照组10例(发育一致性), 双胎发育不一致的定义：双胎胎儿体质量差>20% ［双胎间体质量差别＝ (大胎体质量-小胎体质量)/大胎体质量×100%］。两组间孕产妇年龄及分娩孕周比较差异无统计学意义(P>0.05)。

1. 2方法观察记录有关母亲和新生儿信息, 详细记录孕产妇年龄、孕产次、受孕方法、分娩孕周、分娩方式、孕期并发症、新生儿出生体重、Apgar评分及新生儿结局。

1. 3统计学方法采用SPSS17.0软件, 采用t检验和χ2检验, 检验水准α=0.05。P<0.05表示差异有统计学意义。

2结果

2. 1两组新生儿结局比较观察组新生儿平均体……