双胎妊娠合并完全性前置胎盘的临床特征及围产结局  

Clinical features and perinatal outcomes of twin pregnancies with complete placenta previa

作　　者：王伽略[1] 魏瑗[1] 崔岳毅[1] 杜洁娜 张瑾[3] 石慧峰 赵扬玉[1] Wang Jialüe;Wei Yuan;Cui Yueyi;Du Jiena;Zhang Jin;Shi Huifeng;Zhao Yangyu(Department of Obstetrics and Gynecology,Peking University Third Hospital,Beijing 100191,China;Department of Obstetrics and Gynecology,Beijing Shunyi District Maternal and Child Health Hospital,Beijing 101312,China;Department of Obstetrics and Gynecology,Beijing Shijitan Hospital,Beijing 100038,China)

机构地区：[1]北京大学第三医院妇产科,北京100191 [2]北京市顺义区妇幼保健院妇产科,北京101312 [3]北京世纪坛医院妇产科,北京100038

出　　处：《中华围产医学杂志》2022年第3期179-185,共7页Chinese Journal of Perinatal Medicine

基　　金：首都临床诊疗技术研究及转化应用(Z201100005520074)。

摘　　要：目的探讨双胎妊娠合并完全性前置胎盘(complete placenta previa, CPP)的临床特征以及围产结局。方法 2012年1月至2020年12月在北京大学第三医院分娩的双胎妊娠2 937例, 回顾性分析其中合并CPP的孕妇62例(双胎组)与同期分娩的单胎妊娠合并CPP的孕妇204例(单胎组)的临床资料。采用t检验、非参数检验、χ^(2)检验进行单因素分析, 通过多因素logistic回归或多重线性回归, 比较2组孕妇的妊娠结局和围产儿结局。结果双胎妊娠合并CPP的发生率为2.11%(62/2 937)。胎盘植入性疾病在双胎组和单胎组分别占48.4%(30/62)和53.9%(110/204), 但差异无统计学意义(χ^(2)=0.58, P>0.05)。双胎组产前出血、首次产前出血孕周小于29周、产前出血量>200 ml及产前出血次数≥3次的比例均明显高于单胎组[分别为56.5%(35/62)与39.7%(81/204)、35.5%(22/62)与12.7%(26/204)、17.7%(11/62)与4.9%(10/204)及21.0%(13/62)与10.3%(21/204), χ^(2)值分别为5.42、16.62、10.78和4.86, P值均<0.05]。多因素logistic回归分析显示, 与单胎组相比, 双胎组产前出血量>200 ml、产前出血次数≥3次、34周以及32周前早产、急诊剖宫产及因产前出血而急诊剖宫产的发生风险更高[校正OR值(95%CI)分别为4.36(1.17~16.30)、3.15(1.01~9.79)、17.24(5.36~55.46)、9.85(2.32~41.77)、3.98(1.72~9.20)及3.10(1.22~7.85), P值均<0.05]。多重线性回归分析显示双胎组急诊剖宫产的分娩孕周较单胎组提前2.22周(0.17~4.27周), 但双胎妊娠产后出血量、剖宫产产后出血、输注红细胞和子宫切除的风险与单胎组的差异均无统计学意义。结论与单胎相比, 双胎合并CPP者的早产、急诊剖宫产、尤其是因产前出血而急诊剖宫产比例高。对于双胎合并CPP者, 应积极预防早产, 根据病情个体化安排手术时机, 可考虑适时提前分娩。Objective:To investigate the clinical features and perinatal outcomes of twin pregnancies with complete placenta previa(CPP).Methods:We conducted a retrospective study on 266 women with CPP,including 62 twin pregnancies(twins group)and 204 singleton pregnancies(singleton group),who gave birth in Peking University Third Hospital from January 2012 to December 2020.T-test,nonparametric test and Chi-square test were adopted for univariate analysis.Differences between the two groups regarding clinical features and perinatal outcomes were compared using multivariate logistic regression or multivariate linear regression.Results:The incidence of twin pregnancy with CPP was 2.11%(62/2937).Placenta accreta spectrum disorders(PAS)accounted for 48.4%(30/62)and 53.9%(110/204)in the twin and singleton group,respectively,but the difference was not statistically significant(χ^(2)=0.58,P>0.05).In terms of antepartum hemorrhage,the proportion of women affected,those with first onset<29 weeks,amount of bleeding≥200 ml,and the number of episodes of bleeding≥3 were significantly higher in the twin group than those in the singletons[56.5%(35/62)vs 39.7%(81/204);35.5%(22/62)vs 12.7%(26/204);17.7%(11/62)vs 4.9%(10/204);and 21.0%(13/62)vs 10.3%(21/204),χ^(2)=5.42,16.62,10.78,and 4.86,respectively,all P<0.05].Multivariate Logistic regression analysis showed that compared with the singleton group,the twin group was at higher risk of antepartum hemorrhage volume>200 ml,the number of antepartum hemorrhage episodes≥3,preterm delivery before 34 weeks and 32 weeks,emergency cesarean section,and emergency cesarean section caused by antepartum hemorrhage[a OR(95%CI)=4.36(1.17-16.30),3.15(1.01-9.79),17.24(5.36-55.46),9.85(2.32-41.77),3.98(1.72-9.20),and 3.10(1.22-7.85),respectively,all P<0.05].Multivariate linear regression analysis showed that the gestational week at the emergency cesarean section in the twins group was about 2.22 weeks(0.17-4.27 weeks)earlier than that in the singletons.The postpartum hemorrhage amount and the risk of po

关 键 词：前置胎盘 妊娠 双胎 子宫出血 产后出血 妊娠结局 早产 

分 类 号：R714.23[医药卫生—妇产科学]