双胎妊娠计划阴道分娩妇女实际分娩方案下产妇严重并发症分析  

Serious complications of vaginal delivery of twin pregnancy

作　　者：李小云 涂晓莉 唐琪 余慧 LI Xiao-yun;TU Xiao-li;TANG Qi;YU Hui(Department of Obstetrics,Shiyan Maternity and Child Care Hospital,Shiyan,Hubei 442000,China;不详)

机构地区：[1]十堰市妇幼保健院产科,湖北十堰442000 [2]十堰市太和医院重症医学科,湖北十堰442000 [3]十堰市人民医院湖北医药学院附属人民医院创伤骨科,湖北十堰442000

出　　处：《中国临床研究》2021年第8期1065-1068,共4页Chinese Journal of Clinical Research

摘　　要：目的探讨实际分娩方案对原计划阴道分娩双胎妊娠妇女严重急性孕产妇疾病(SAMM)发病的影响。方法应用前瞻性队列研究方法,以计划阴道分娩的双胎妊娠妇女作为研究对象。根据妇女实际的分娩方案分为3组:双胞胎阴道分娩、双胞胎剖宫产、第2个胎儿剖宫产。对比分析不同实际分娩方案下3组妇女的SAMM发病率,并探讨影响计划阴道分娩妇女转剖宫产分娩双胞胎的相关因素。结果 3 069例原计划阴道分娩的双胎妊娠妇女中,2 415例(78.69%)通过阴道分娩双胞胎,512例(16.68%)通过剖宫产分娩双胞胎,142例(4.63%)第2个胎儿进行了剖宫产。双胞胎阴道分娩妇女的SAMM发病率为3.98%,双胞胎剖宫产妇女的SAMM发病率为10.16%,第2个胎儿剖宫产分娩妇女的SAMM发病率为8.45%。年龄较大、初产妇、有既往剖宫产史、采用辅助生殖技术、巨大儿是计划阴道分娩妇女转而剖宫产分娩双胞胎的危险因素(P<0.01),其OR(95%CI)分别为2.682(1.524~4.719)、1.893(1.350~2.653)、1.565(1.144~2.142)、2.894(1.668~5.020)、2.067(1.216~3.514)。结论阴道分娩是双胎妊娠妇女相对安全的分娩方案。Objective To investigate the influences of actual delivery mode on the incidence of severe acute maternal morbidity(SAMM) in women with twin pregnancy and planned vaginal delivery.Methods A prospective cohort study was conducted in women with twin pregnancy scheduled for vaginal delivery.According to women′s actual delivery modes, they were divided into the vaginal delivery group, the cesarean section group and the cesarean section for the second twin group.The incidences of SAMM were compared among three groups, and the related factors for transferring of vaginal delivery to cesarean section were analyzed.Results Of 3 069 twin pregnant women, there were 2 415(78.69%)women in vaginal delivery group, 512(16.68%) women in cesarean section group and 142(4.63%) women in cesarean section for the second twin group.The incidence rates of SAMM were 3.98% in women with vaginal delivery, 10.16% in women with cesarean section and 8.45% in women with cesarean section for the second twin, respectively.The related risk factors for transferring from planned vaginal delivery to cesarean section were older maternal age[OR=2.682,95%CI(1.524-4.719)],primipara[OR=1.893,95%CI(1.350-2.653)],previous history of cesarean section[OR=1.565,95%CI(1.144-2.142)],assisted reproductive technology[OR=2.894, 95%CI(1.668-5.020)] and macrosomia [OR=2.067,95%CI(1.216-3.514)](P<0.01).Conclusion Vaginal delivery is a relatively safe delivery mode for twin pregnant women.

关 键 词：双胎 计划阴道分娩 实际分娩方案 严重急性孕产妇疾病 并发症 

分 类 号：R714.432[医药卫生—妇产科学]