单绒双羊与双绒双羊双胎产妇分娩孕周与分娩方式选择

摘要

目的 分析单绒毛膜双羊膜囊(单绒双羊)与双绒毛膜双羊膜囊(双绒双羊)双胎产妇分娩孕周和分娩方式选择及其与妊娠结局的相关性.方法 回顾性收集陕西省宝鸡市妇幼保健院于2016年1月至2017年3月收治的128例非复杂性双胎妊娠的产妇资料,其中单绒双羊双胎21例为M组,双绒双羊双胎107例为D组.记录两组临床基本情况,比较分娩孕周 、妊娠期并发症与合并症 、分娩方式及妊娠结局等情况,对两组分娩孕周 、分娩方式选择与妊娠结局的关系进行相关性分析.结果 M组阴道分娩1例(4.76%),D组4例(3.74%).D组产妇不良结局的发生率(19.63%)稍高于M组(14.29%),但无显著性差异(χ2=0.98,P>0.05).M组新生儿不良结局发生率(76.19%)显著高于D组(49.53%),差异具有统计学意义(χ2=12.97,P<0.01).M组孕<35周分娩新生儿重症监护病房(NICU)入住率明显高于孕36～37周(χ2=23.24,P<0.01);D组孕<35周分娩的新生儿呼吸窘迫综合征 、NICU入住率与其他新生儿疾病发生率均显著高于孕36～38周分娩者(χ2值分别为11.23、17.65、17.24,均P<0.01),并且孕37周分娩时新生儿病理性黄疸发生率显著低于孕38周分娩者(χ2=13.17,P<0.01).结论 单绒双羊双胎与双绒双羊双胎者在孕36～37周分娩时新生儿不良结局发生率较低,应按照孕妇宫内双胎情况进行评估,选择更为适宜的分娩方式,尽可能降低不良妊娠结局的发生率.%Objective To analyze the maternal gestational weeks of monochorionic diamnionic twin pregnancy and dichorionic diamnionic twin pregnancy and choice of delivery mode as well as their relationship with pregnancy outcomes .Methods A retrospective analysis was conducted on 128 pregnant women with uncomplicated twin pregnancy , including 21 cases of monochorionic diamnionic twin pregnancy as group M and 107 cases of dichorionic diamnionic twin pregnancy as group D .The gestational weeks ,complications of pregnancy , delivery mode and pregnancy outcomes and other clinical basic indexes were compared between two groups ,and the correlation among gestational weeks ,delivery mode and pregnancy outcomes was analyzed .Results There was 1 case (4 .76% ) of vaginal delivery in group M and 4 cases (3 .74% ) in group D .The incidence rate of maternal adverse outcomes in group D (19 .63% ) was slightly higher than that of group M (14 .29% ) ,but there was no significant difference between them (χ2 = 0 .98 , P > 0 .05) .The incidence rate of neonatal adverse outcomes in group M (76 .19% ) was significantly higher than that in group D (49 .53% ) ,which showed statistical difference (χ2 = 12 .97 ,P < 0 .01) .The occupancy rate of neonates delivered before 35 gestational weeks in intensive care unit (NICU ) in group M was significantly higher than that of those delivered during 36 - 37 weeks of gestation (χ2 = 23 .24 ,P < 0 .01) ,and the rate of neonatal respiratory distress syndrome ,NICU occupancy and other neonatal diseases in neonates delivered before 35 gestational weeks were significantly higher than those during 36 - 38 weeks of gestation in group D (χ2 value was 11 .23 ,17 .65 and 17 .24 ,respectively ,all P < 0 .01) ,and the rate of neonatal jaundice with 37 weeks of gestation was significantly lower than that of 38 weeks of gestation (χ2 = 13 .17 ,P < 0 .01 ) .Conclusion The monochorionic diamnionic twin pregnancy and dichorionic diamnionic twin pregnancy at 36 - 37 weeks of gestation have lower incidence rate of neonatal adverse outcomes , which shows that appropriate delivery mode should be chosen by evaluating intrauterine twin pregnancy to reduce the incidence rate of adverse pregnancy outcomes as far as possible .