双胎妊娠孕期规范化诊疗和管理对围产儿预后影响研究

摘要

Objective To compare the accuracy of diagnosis and the prognosis of twin pregnancies before and after the standardized diagnosis and management of twin pregnancies is implemented.Methods A total of 444 cases who had delivery in the Obstetrics and Gynecology Hospital of Fudan University from 1 January 2010 to 31 December 2015 were enrolled,whose chorionicity was defined by visual examination or placental pathology after birth.By the date of implementing the standardized diagnosis and management of twin pregnancies from 1 June 2013,cases were divided into two groups,and we compared the accuracy of chorionic diagnosis,pregnancy and perinatal outcome.Results (1) There was no significant difference in age,height and weight between the two groups (P ＞ 0.05).(2)After the implementation,the proportion of diagnosis of chorionicity by ultrasonography increased significantly (91.7％ vs.70.2％,P ＜ 0.01).The proportion of chorionicity that was diagnosed by the number of gestational sacs increased significantly after the implementation (71.7％ vs.60.0％,P＜0.01).Two cases were misdiagonosed before the implementation and no case was misdiagonosed after the implementation;however,there was no significant difference in the accuracy of diagnosis of chorionicity between two groups (P ＞ 0.05).(3)The delivery week of elective cesarean section was significantly later after implementation than before the implementation (37.17± 0.45weeks vs.36.93±0.51 weeks,P ＜ 0.01),so was the delivery week of elective cesarean section in dichorionic twin gestations (37.32-±0.32 weeks vs.37.03±0.46 weeks,P ＜0.01).(4)There was no significant difference in neonatal birth weight between the two groups (P＞ 0.05).The proportion of maternal-with-infant after implementation was higher than that before the implementation (58.3％ vs.54.1％,P ＜ 0.05).The proportion of newborns admitted to the NICU,transferred after born or giving up rescue was lower than that before the implementation (37.4％ vs.37.7％,4.3％ vs.7.3％,0 vs.0.9％,P ＜ 0.05).Conclusion The standardized diagnosis and management of twin pregnancies is conducive to improving perinatal outcome.%目的 探讨双胎妊娠诊治规范和管理模式建立前后双胎妊娠绒毛膜性诊断的准确性和围产儿预后的改变.方法 收集2010-01-01-2015-12-31在复旦大学附属妇产科医院杨浦院区产科分娩、经产后肉眼检查或胎盘胎膜病理检查明确绒毛膜性质的双胎妊娠孕妇444例,以本院2013-06-01起对双胎妊娠实施规范化诊疗和管理(简称“规范”)为界分组,比较规范实施前后绒毛膜性诊断的准确性、妊娠结局及围产儿预后方面的差异.结果 (1)规范实施前后,收集病例的年龄、身高、体重之间差异无统计学意义(P＞0.05).(2)规范实施后,产前超声诊断绒毛膜性的比例较实施前明显增加(91.7％ vs.70.2％,P＜0.01),根据超声检查孕囊个数诊断绒毛膜性的比例明显增加(71.7％vs.60.0％,P＜0.01);规范实施前有2例产后与产前绒毛膜性诊断不相符,规范实施后诊断均相符,但总体绒毛膜性的诊断准确率差异无统计学意义(P＞0.05).(3)规范实施后的择期剖宫产分娩孕周明显晚于规范实施前[(37.17±0.45)周vs.(36.93±0.51)周,P＜0.01],其中双绒毛膜双胎择期剖宫产分娩孕周在规范实施后亦明显晚于规范实施前[(37.32±0.32)周vs.(37.03±0.46)周,P＜0.01].(4)规范实施前后的新生儿出生体重差异无统计学意义(P＞0.05),母婴同室比例在规范实施后高于规范实施前(58.3％ vs.54.1％,P＜0.05),新生儿NICU入住率、出生后直接转院比例及放弃抢救比例低于规范实施前(37.4％ vs.37.7％,4.3％ vs.7.3％,0 vs.0.9％,P＜0.05).结论 双胎妊娠诊治规范和管理模式的建立有利于围产儿预后的改善.