双胎妊娠在不同孕周分娩方式选择与结局的临床分析  

Choice of twin pregnancy delivery mode in different gestational age with outcome analysis

作　　者：杨婧[1] 周玮[1] 

机构地区：[1]重庆市妇幼保健院产科,400000

出　　处：《重庆医学》2017年第3期344-346,共3页Chongqing medicine

基　　金：重庆市卫生计生委2016年医学科研计划项目(2016MSXM091)

摘　　要：目的探讨不同孕周双胎妊娠病例的分娩方式与妊娠结局的关系。方法选择2014年8月至2015年12月在该院分娩的孕周分别为28~33^(+6)周,34~36^(+6)周及37~39周(分为A、B、C 3组)的270例双胎妊娠孕妇及其分娩的新生儿作为研究对象。回顾性分析在不同孕周,分娩方式与产妇分娩并发症、胎位、新生儿体质量、新生儿窒息率的关系,同时记录了绒毛膜性与分娩孕周的关系。结果 3组孕周中,不同分娩方式的产后出血发生率比较差异无统计学意义(P>0.05)。B组阴道分娩组第2胎新生儿窒息2例,剖宫产组第2胎新生儿窒息1例,差异有统计学意义(P<0.05);B组中剖宫产组新生儿体质量显著高于阴道分娩组(P<0.05)。50%单绒毛膜双羊膜囊及51%双绒毛膜双羊膜囊双胎于34~36+6周剖宫产终止妊娠。结论暂无确切证据证明在某一孕周剖宫产对于妊娠结局优于阴道分娩,但随孕周及胎儿体质量的增加,应放宽剖宫产指征,以避免阴道试产过程可能发生的风险。Objective To explore the outcome with choice of twin pregnancy delivery mode in different gestational age.Methods A retrospective study was used to obtain histories of 270 twin pregnancy pregnant women and newborn in gestational weeks in28-33^（＋6） weeks,34-36^（＋6） weeks and 37-39weeks（divided into group A,B,C）from Aug 2014 to Dec 2015 in Chongqing healthcenter for women and children.According to retrospective analysis among gestational weeks,the relation with mode of delivery and complication,position of fetus,weight of newborn and Asphyxia of newborn rate were showed.Meanwhile,the relation with chorionic property and delivery gestational weeks were recorded in retrospective analysis.Results There was no statistical difference in the rate of postpartum hemorrhage of different delivery modes in 3gestational weeks（P〈0.05）;there were two second newborn in natural labor group and one in C-sect group of group B occurred Asphyxia（P〈0.05）;there were statistical differences in weight of fetus from different delivery mode in group B（P〈0.05）.About 50% Monochorionic diamnionic twin pregnancies and 51% Double chorionic diamnionic twin pregnancies C-sected to termination of pregnancy during 34 weeks to 36＋6 weeks.Conclusion No conclusive evidence in some weeks C-sect is better than natural labor for pregnancy outcome.With the increasing of the weight of newborns and gestational weeks,relax the restriction of C-sect to reduce the possible risk of natural labor.

关 键 词：分娩方式 双胎妊娠 绒毛膜性 新生儿窒息 产后出血 

分 类 号：R714.23[医药卫生—妇产科学]