胎膜内分娩在双胎妊娠早产中的应用  

En caul vaginal delivery of the second preterm infant in twin pregnancy

作　　者：颜昊[1] 陈敦金[1] 林琳[1] 柯彩萍[1] 黄赟博[1] 王晓怡[1] YAN Hao;CHEN Dun-jin;LIN Lin;KE Cai-ping;HUANG Yun-bo;WANG Xiao-yi(Department of Obstetrics and Gynecology,the Third Affiliated Hospital of Guangzhou Medical University,Key Laboratory for Major Obstetric Diseases of Guangdong Province,Guangzhou 510150,China)

机构地区：[1]广州医科大学附属第三医院妇产科广州重症孕产妇救治中心广东省产科重大疾病重点实验室,广东广州510150

出　　处：《中国实用妇科与产科杂志》2018年第8期913-917,共5页Chinese Journal of Practical Gynecology and Obstetrics

摘　　要：目的探讨在双胎妊娠早产中应用胎膜内分娩娩出第二胎,分析其对第二胎新生儿结局和产程进展的影响。方法 2016年5月至2018年2月在广州医科大学附属第三医院经阴道分娩的双胎妊娠早产孕妇181例,随机分为胎膜内分娩组和对照组,观察胎膜内分娩成功率与第二胎出生体重及分娩孕周的关系,以及胎膜内分娩对第二胎出生后1min和5min Apgar评分,脐动脉血血气分析p H值,乳酸含量,血红蛋白含量和第二胎产伤以及产程进展的影响。结果 (1)胎膜内分娩成功组第二胎出生体重为(1343.5±409.1)g,明显低于胎膜内分娩失败组(P<0.05),胎膜内分娩成功组分娩孕周为(30.8±2.4)周,明显小于胎膜内分娩失败组(P<0.05)。(2)胎膜内分娩成功组第二胎脐动脉血血气分析乳酸含量为(4.0±0.9)mmol/L,较胎膜内分娩失败组[(5.4±0.3)mmol/L]明显降低(P<0.05)。(3)胎膜内分娩成功组第二胎脐动脉血血气分析血红蛋白含量较胎膜内分娩失败组无明显降低(P>0.05)。(4)胎膜内分娩失败组第二胎,头位分娩3例(15.8%)发生颅内出血;臀位分娩2例(6.5%)发生先露部淤伤,较胎膜内分娩成功组[头位分娩无一例(0/11)发生颅内出血;臀位分娩无一例(0/30)发生先露部淤伤]明显升高(P<0.05)。(5)胎膜内分娩成功组第二胎第三产程较胎膜内分娩失败组明显缩短(P<0.05)。结论小孕周双胎早产及第二胎低出生体重采用胎膜内分娩成功率明显升高,胎膜内分娩有利于改善第二胎的分娩结局。Objective To describe the vaginal delivery of second fetus in preterm birth of twin pregnancy within intact amniotic sac,and to compare the immediate neonatl outcomes of the second fetus and stages of labor with those delivered with non-intact amniotic sac.Methods Totally 181 preterm twins were selected from May,2016 to Feb,2018 in the Third Affiliated Hospital of Guangzhou Medical University,and were randomly divided into‘En caul＇vaginal delivery group and control group. The relationship between gestational week and birth weight of second fetus and the success rate of＂En caul＂births was evaluated. Apgar scores,umbilical cord artery blood gas p H,lactate,hemoglobin and birth injury of the second fetus also the stages of labor were noted.Results （1）The birth weight of second fetus of successful En caul vaginal delivery group was（1343.5±409.1）g,significantly lower than that of failure group（P〈0.05）,and gestational week of successful group was（30.8±2.4）weeks,apparently lower than that of failure group（P〈0.05）.（2）Compared with the failure group[（5.4±0.3）mmol/L],the cord artery blood lactate of successful group[（4.0±0.9）mmol/L]decreased significantly（P〈0.05）.（3）The cord artery blood hemoglobin of successful group showed no marked decrease（P〉0.05）.（4）In the failure group,3 cases（15.8%）of the cerphalic presentation had intracranial hemorrhage,2 cases（6.5%）of the breech presentation had bruising injuries,both significantly higher than those of successful group（P〈0.05）（0/11 with the cerphalic presentation showed intracranial hemorrhage and 0/30 with the breech presentation presented bruising injuries）.（5）The third stage of labor of successful group was significantly shorter than the failure group（P〈0.05）.Conclusion （1）The success rate of En caul vaginal delivery apparently increases in the cases of small gestational week and lower birth weight of the second fetus,and en caul vaginal delivery can improve the birth outcomes o

关 键 词：阴道分娩 胎膜内 双胎 早产 

分 类 号：R714.432[医药卫生—妇产科学]