非复杂性双胎妊娠的分娩时机与分娩方式  

Timing and mode of delivery for uncomplicated twin pregnancies

作　　者：刘培培[1] 祝彩霞[1] 陈海天[1] 王子莲[1] 

机构地区：[1]中山大学附属第一医院妇产科,广州510080

出　　处：《中华围产医学杂志》2016年第12期903-909,共7页Chinese Journal of Perinatal Medicine

基　　金：国家卫计委公益性行业科研专项项目（201402006）

摘　　要：目的探讨非复杂性双胎妊娠分娩时机和分娩方式与妊娠结局的关系，为临床非复杂性双胎妊娠最佳分娩时机和分娩方式的选择提供理论依据。方法选择2012年11月至2015年6月在中山大学附属第一医院产科分娩的347例非复杂性双胎进行回顾性分析，根据绒毛膜性不同分为双绒毛膜双羊膜囊双胎（dichorionic diamniotic twin pregnancy，DCDA）组（291例）和单绒毛膜双羊膜囊双胎（monochorionic diamniotic twin pregnancy，MCDA）组（56例）。记录孕产妇的一般情况、妊娠期合并症和并发症、分娩孕周、分娩方式及妊娠结局等，并分析DCDA组和MCDA组的分娩孕周和分娩方式与妊娠结局之间的关系。采用t检验、χ^2检验或Fisher检验，以及logistic回归分析对数据进行统计分析。结果（1）DCDA组不良新生儿结局的发生率为49.1%（281/572），明显低于MCDA组的75.5%（83/110）（χ^2=25.698，P〈0.05）。DCDA组中，在36~36周^＋6、37~37周^＋6、38~38周^＋6分娩时新生儿重症监护病房（neonatal intensive care unit，NICU）的入住率、新生儿呼吸窘迫综合征（neonatal respiratory distress syndrome，NRDS）的发生率及其他新生儿疾病的发生率均明显低于在〈34周、34~34周＋6、35~35周＋6分娩者（P值均〈0.05），而在38~38周^＋6分娩时新生儿病理性黄疸的发生率为2/8，明显高于在36~36周^＋6、37~37周^＋6分娩者（分别为3.1%和1.9%，χ^2值分别为10.133和13.510，P值均〈0.05）；MCDA组中，新生儿NICU入住率从〈35周分娩时的100.0%（30/30）逐渐降低至37~37周^＋6分娩时的3/12。DCDA组35~35周^＋6、36~36周^＋6、37~37周^＋6分娩时不良新生儿结局的OR值（95%CI）分别为0.237（0.116~0.482）、0.056（0.029~0.108）及0.054（0.026~0.112）（P值均〈0.05），MCDA组34~34周^＋6和35~35周^＋6分娩时不良新生儿结局的OR值（95%CI）分别为38.894（3.084~490.552）和18.858（1.538~231.222）�Objective To investigate the relationship between time and mode of delivery and gestational outcomes in uncomplicated twin pregnancies.Methods A total of 347 women with uncomplicated twin pregnancies who gave birth in First Affiliated Hospital of Sun Yat-Sen University between November 2012 and June 2015 were reviewed retrospectively, including 291 dichorionic diamniotic twin pregnancies （DCDA） and 56 monochorionic diamniotic twin pregnancies （MCDA）. The general information, gestational complications, time and mode of delivery, gestational outcomes were recorded and the relationship between time and mode of delivery and gestational outcomes in DCDA and MCDA groups were analyzed. T test, Chi-square, Fisher＇s exact test and logistic regression analysis were used for statistical analysis.Results （1） The incidence of adverse neonatal outcomes in DCDA group [49.1% （281/572）] was significantly lower than in MCDA group [75.5% （83/110）] （χ^2=25.698, P〈0.05）. In DCDA group, women delivered at 36-36＋6 weeks, 37-37＋6 weeks and 38-38＋6 weeks had lower rates of admission to neonatal intensive care unit （NICU）, neonatal respiratory distress syndrome （NRDS） and other neonatal diseases than those delivered at 〈34 weeks, 34-34^＋6 weeks and 35-35^＋6 weeks （all P〈0.05）, while those delivered at 38-38^＋6 weeks had a higher incidence of pathological jaundice （2/8） than at 36-36^＋6 weeks and 37-37^＋6 weeks （3.1% and 1.9%） （χ^2=10.133 and 13.510, both P〈0.05）. In MCDA group, the rate of admission to the NICU decreased gradually from 100.0% （30/30） （〈35 weeks） to 3/12 （37-37^＋6 weeks） （P〈0.05）. In DCDA group, the odds ratio （OR） and 95% confidence interval（95%CI） of adverse neonatal outcomes in 35-35^＋6, 36-36^＋6 and 37-37^＋6 weeks were 0.237（0.116-0.482）, 0.056（0.029-0.108） and 0.054（0.026-0.112）, respectively （all P〈0.05）. In MCDA group, OR （95%CI） of adverse neonatal outcomes in 34-34^＋6 and 35-35^�

关 键 词：妊娠 双胎 妊娠并发症 分娩 接生 产科 妊娠结局 

分 类 号：R714[医药卫生—妇产科学]