摘要
目的分析多胎妊娠中延迟分娩(delayed-interval delivery,DID)胎儿的胎儿及早期新生儿死亡率,初步探究绒毛膜性及出生胎龄对DID及早期新生儿死亡率的影响。方法计算机检索PubMed、Web of Science、Embase、Elsevier、万方数据知识服务平台、中国知网及中华医学期刊全文数据库自建库至2024年12月收录的关于延迟分娩、多胎妊娠的文献,筛选相关文献,提取原始资料,应用描述性统计、Fisher确切概率法检验进行数据分析,探讨DID胎儿、早期新生儿死亡率,以及绒毛膜性、出生胎龄对二者的影响。结果共纳入63篇文献、211例DID胎儿,其中9例因于孕20周前发生宫内死亡未纳入分析,最终纳入分析202例。胎龄20~23^(+6)周组34例,24~27^(+6)周组76例,28~33^(+6)周组69例,34~36^(+6)周组11例,37~41^(+6)周组12例,组间比较结果显示,胎龄20~23^(+6)周组DID胎儿死亡率(38.2%)最高,与24~27^(+6)周组(10.5%)、28~33^(+6)周组(2.9%)比较,差异均有统计学意义(P<0.05);胎龄20~23^(+6)周组早期新生儿死亡率(78.6%)最高,与24~27^(+6)周组(20.9%)、28~33^(+6)周组(4.5%)、34~36^(+6)周组(0.0%)及37~41^(+6)周组(0.0%)比较,差异均有统计学意义(P<0.05);但28~33^(+6)周组、34~36^(+6)周组、37~41^(+6)周组组间DID胎儿及早期新生儿死亡率比较,差异无统计学意义(P>0.05)。单绒毛膜双羊膜囊组14例,双绒毛膜双羊膜囊组139例,双绒毛膜三羊膜囊组14例,三绒毛膜三羊膜囊组34例,四绒毛膜四羊膜囊组1例,不同绒毛膜性组间DID胎儿及早期新生儿死亡率均无显著性差异(P>0.05)。结论胎龄28~33^(+6)周是DID胎儿较为适宜的分娩时机,孕周延长至34周后,胎儿及早期新生儿死亡率未进一步显著降低,但鉴于母体并发症风险,当胎儿达34周时,应权衡继续延迟分娩的利弊;绒毛膜性对DID胎儿及早期新生儿死亡率无明显影响。
ObjectiveTo study gestational age(GA)and perinatal mortality in delayed-interval delivery(DID)of multiple pregnancy and to determine the effects of chorionicity and GA on clinical outcomes.MethodsFrom inception of the databases to December 2024,literature on DID and multiple pregnancy were searched in seven medical databases.The clinical data were extracted.Perinatal mortality and the association with chorionicity and GA were analyzed using descriptive statistics or Fisher's exact tests.ResultsA total of 63 articles and 212 cases of DID fetuses were retrieved.9 cases of intrauterine death before GA 20 weeks were excluded and 202 cases were analyzed eventually.34,76,69,11 and 12 cases were in the 20-23^(+6) weeks,24-27^(+6) weeks,28-33^(+6) weeks,34-36^(+6) weeks and 37-41^(+6) weeks groups,respectively.The fetal mortality of DID cases was the highest in the 20-23^(+6) weeks group(38.2%),which was statistically significant compared with that in 24-27^(+6) weeks group(10.5%)and 28-33^(+6) weeks group(2.9%)(P<0.05).Perinatal mortality in the 20-23^(+6) weeks group(78.6%)were the highest among all groups(all P<0.05).No significant differences existed in perinatal mortality among 28-33^(+6) weeks,34-36^(+6) weeks and 37-41^(+6) weeks groups(P>0.05).14 cases were monochorionic diamniotic,139 cases were dichorionic diamniotic,14 cases were dichorionic triamniotic,34 cases were trichorionic triamniotic and 1 case was quadrichorionic quadriamniotic.No significant differences of perinatal mortality existed among these chorionicity groups(P>0.05).ConclusionsGA 28-33^(+6) weeks is more suitable for DID.GA>34 weeks does not effectively reduce perinatal mortality.Given the risk of maternal complications,the pros and cons of DID should be carefully weighed if GA>34 weeks.Chorionicity shows no significant effects on perinatal mortality of DID.
作者
周娴璐
曾仕诚
华子瑜
Zhou Xianlu;Zeng Shicheng;Hua Ziyu(Department of Neonatology,Children's Hospital of Chongqing Medical University,National Clinical Research Center for Child Health and Disorders,Ministry of Education Key Laboratory of Child Development and Disorders,Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity,Chongqing 400014,China)
关键词
多胎妊娠
双胎妊娠
延迟分娩
早期新生儿死亡率
Multiple pregnancy
Twin pregnancy
Delayed-interval delivery
Early neonatal mortality
