高龄对双胎妊娠初产的影响分析  

Influence of advanced age on twin pregnancy in nulliparous women

作　　者：祝彩霞[1] 熊玮[2] 陈汉青[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 [2]中山大学附属第一医院麻醉科,广州510080

出　　处：《新医学》2017年第10期722-726,共5页Journal of New Medicine

基　　金：卫生部行业科研专项(合作)(201402006)

摘　　要：目的探讨高龄初产双胎妊娠的临床特点及高龄对双胎妊娠初产妇母儿结局的影响。方法纳入453例双胎妊娠初产妇,收集其病历资料,按年龄分适龄(<35岁)组和高龄(≥35岁)组。比较2组双胎妊娠初产妇的临床特点及母儿结局。使用Logistic回归分析双胎妊娠初产妇产后出血和新生儿不良结局的影响因素。结果 453例双胎妊娠初产妇中,高龄组82例、适龄组371例,高龄组中辅助受孕率(84.1%)和双绒毛膜双羊毛膜双胎比例(81.7%)均高于适龄组(P均<0.01)。高龄组的GDM(36.6%)、产后出血(30.5%)和新生儿不良结局(47.2%)发生率均高于适龄组(P均<0.05)。Logistic回归显示,高龄是双胎妊娠初产妇发生产后出血(校正OR=2.133,95%CI 1.218~3.738,P<0.05)和新生儿不良结局(校正OR=1.681,95%CI 1.148~2.462,P<0.01)的危险因素。选择性宫内生长受限是产后出血的保护因素(校正OR=0.310,95%CI 0.118~0.816,P<0.05),但预示新生儿不良妊娠结局(校正OR=0.1.760,95%CI 1.102~2.809,P<0.05)。结论高龄是双胎妊娠初产妇出现产后出血和新生儿不良结局的危险因素。Objective To investigate the clinical characteristics of nulliparous women aged ≥ 35 years with twin pregnancy and the effect of advanced age upon the material and neonatal outcomes. Methods Clinical data of 453 nulliparous women with twin pregnancy were collected. All participants were assigned into the < 35 years and ≥35 years groups according to age. Clinical characteristics and maternal and neonatal outcomes of nulliparous women with twin pregnancy were statistically compared between two groups. The risk factors of postpartum hemorrhage and adverse neonatal outcomes in nulliparous women with twin pregnancy were identified by logistic regression analysis. Results Among 453 nulliparous women with twin pregnancy,82 cases were assigned into the ≥35 years group,and 371 in the < 35 years group. In the ≥35 years group,the pregnancy rate of assisted reproductive technology was 84. 1% and the percentage of dichorionic diamniotic twins was 81. 7%,significantly higher compared with those in the < 35 years group( both P < 0. 01). In the≥35 years group,the incidence of gestational diabetes mellitus( 36. 6%),postpartum hemorrhage( 30. 5%)and adverse neonatal outcomes( 47. 2%) were remarkably higher than those in the < 35 years group( all P <0. 05). Logistic regression analysis revealed that advanced age was a risk factor of postpartum hemorrhage( adjusted OR = 2. 133,95% CI = 1. 218-3. 738,P < 0. 05) and adverse neonatal outcomes( adjusted OR =1. 681,95% CI = 1. 148-2. 462,P < 0. 01). Selective intrauterine growth restriction was a protective factor of postpartum hemorrhage( adjusted OR = 0. 310,95% CI = 0. 118-0. 816,P < 0. 05) and predicted the incidence of adverse neonatal outcomes( adjusted OR = 1. 760,95% CI = 1. 102-2. 809,P < 0. 05). Conclusion Advanced age is a risk factor of postpartum hemorrhage and adverse neonatal outcomes in nulliparous women with twin pregnancy.

关 键 词：高龄 初产 双胎妊娠 妊娠结局 

分 类 号：R714.23[医药卫生—妇产科学]