摘要
目的分析双胎妊娠的临床特点,探讨引起不良妊娠结局的影响因素。方法随机选取149例2000年1月—2011年12月期间分娩的双胎妊娠产妇,依据分娩方式不同分成2组。其中,阴道分娩组34例,手术分娩组115例。对2组病例资料进行对比分析,主要包括孕妇年龄、孕产次、受孕方式、分娩孕周、分娩方式、孕期并发症、新生儿体重、Apgar评分及围产儿预后等指标,探讨引起不良妊娠结局的影响因素。结果二种分娩方式产后出血发生率无统计学差异,阴道分娩组新生儿窒息及围产儿死亡率高于手术分娩组(P均<0.05)。孕周增加,围产儿死亡率及新生儿窒息率逐渐降低。围产儿死亡率妊娠<34周者高于≥34周者;新生儿窒息率妊娠<32周者高于≥32周者(P均<0.05)。胎儿出生体重增加,围产儿死亡率和新生儿窒息率逐渐降低(P<0.05)。Logistic回归分析提示在相同孕周下,围产儿体重对预后影响最为明显(P<0.05)。结论影响双胎妊娠结局主要因素有分娩方式、分娩孕周及胎儿体重。改善双胎宫内发育环境,促进胎儿体重增加和器官成熟,延长孕周,选择合适的分娩时机与方式,适当放宽剖宫产指征,有助于改善母婴尤其是围产儿预后。
Objective To investigate the clinical features of twin pregnancies,and to explore factors causing adverse pregnancy outcomes. Methods 149 cases of twins mothers during pregnancy from January 2000 to December 2011 were selected and divided into two groups according to the mode of delivery. Among them,34 cases in the vaginal delivery group,115 cases in operative delivery group. Data（ including maternal age,maternal times,conceive ways gestational age,mode of delivery,pregnancy complications,birth weight,Apgar score and perinatal outcome and other indicators） for the two groups were compared and analyzed to explore the factors causing adverse pregnancy outcomes. Results The two kinds of mode of delivery rate of postpartum hemorrhage had no significant difference between the vaginal delivery group and operative delivery group. Neonatal asphyxia and perinatal mortality rates in group were higher than those of the operation delivery（ P〈0. 05）. With the increase of the gestational weeks,perinatal mortality and neonatal asphyxia rate gradually decreased. The perinatal mortality rate in 34 weeks of pregnancy was higher than that of ≥34 weeks of pregnancy; neonatal asphyxia rate in 32 weeks of pregnancy was higher than that of ≥32 weeks（ P〈0. 05）. With the increase of fetal birth weight,perinatal mortality rate and neonatal asphyxia rate gradually decreased（ P〈0. 05）. Logistic regression analysis showed that in the same gestational weeks,confining effect on the prognosis of perinatal weight was most evident（ P〈0. 05）. Conclusion The main factors affecting the outcome of twin pregnancies had a mode of delivery,gestational age and birth weight. To improve twins intrauterine growth environment,and promote weight gain and fetal organs mature and prolong gestation,select the appropriate timing and manner of delivery,cesarean section appropriate to relax will help to improve maternal and child especially perinatal outcome.
出处
《中华全科医学》
2015年第2期232-234,共3页
Chinese Journal of General Practice
