双胎阴道试产的产程特点与母儿结局分析  

Characteristics of labor, maternal and fetal outcomes of vaginal delivery in twins

作　　者：张璐 郁云云 吴江南 顾蔚蓉 刘海燕 ZHANG Lu;YU Yun-yun;WU Jiang-nan;GU Wei-rong;LIU Hai-yan(Department of Obstetrics and Gynecology,Obstetrics and Gynecology Hospital,Fudan University,Shanghai 200011,China;Department of Epidemiology,Obstetrics and Gynecology Hospital,Fudan University,Shanghai 200011,China;Department of Obstetrics,Qidong Maternal and Child Health Hospital,Qidong 226200,Jiangsu Province,China)

机构地区：[1]复旦大学附属妇产科医院妇产科,上海200011 [2]复旦大学附属妇产科医院流行病学教研室,上海200011 [3]江苏省启东市妇幼保健院产科,启东226200

出　　处：《复旦学报（医学版）》2023年第1期80-86,153,共8页Fudan University Journal of Medical Sciences

基　　金：国家自然科学基金(81801469)。

摘　　要：目的 探讨双胎妊娠阴道试产孕妇的产程特点、母儿结局及两者的相关性。方法 本回顾性队列研究纳入2016年1月1日—2020年12月31日在复旦大学附属妇产科医院阴道试产的双活胎孕妇145例。收集孕妇的基线信息、产程时限及母儿结局。其中双胎自然临产的病例共81例,综合引产64例,比较两组的产程及母儿结局。结果 研究时间段内我院双活胎分娩2 198例,其中145例(6.6%)阴道试产。双胎均阴道分娩125例(86.2%),中转剖宫产20例(13.8%),包括一胎阴道分娩一胎剖宫产分娩(复合分娩)4例(2.8%),两胎均剖宫产分娩16例(11.0%)。中位分娩孕周36^(+3)周(28~38^(+5)周),中位第一产程时长220 min(63~1 260 min),中位第二产程时长41min(8~215 min)。产钳助产11例(8.8%),新生儿1分钟Apgar评分≤7分4例(1.4%,2例发生于复合分娩)。产后出血24例(16.5%),其中复合分娩产后出血发生率25.0%,阴道分娩17.6%。在校正孕周、产次及新生儿体重因素之后,发现第二产程越长,产后出血发生风险越高(P=0.01),且第二产程时长与产后出血量正相关,但差异无统计学意义(P=0.28)。在校正综合引产与自然临产组的产次、孕前BMI、孕周、新生儿出生体重等混杂因素后,两组的中转剖宫产率、产后出血率、产后出血量、产程时间、产钳使用、侧切率、会阴Ⅲ~Ⅳ度裂伤、新生儿1分钟Apgar评分≤7分等母儿结局比较,差异均无统计学意义。结论 双胎阴道试产的不良母儿结局主要发生于复合分娩病例,第二产程越长、产后出血风险越高,应积极处理第二产程。适时的双胎综合引产未增加不良母儿结局。Objective To discuss the duration of labor, maternal and fetal outcome of vaginal delivery in twin pregnancies, and their relations. Methods This research included a retrospective cohort study of live twin vaginal delivery in Obstetrics and Gynecology Hospital of Fudan University from Jan 1st2016 to Dec 31st2020. A total of 145 vaginal delivery cases were enrolled, with 81 cases of spontaneous onset and 64 cases of induced onset. The general information, labor modes, maternal and fetal outcomes were analyzed and compared between these two groups. Results Out of 2 198 twin deliveries during the study period, 145 women underwent vaginal delivery, among which 125(86.2%) cases were delivered vaginally, 4(2.8%) cases were vaginal-cesarean combined delivery and the remaining 16(11.0%) underwent caesarean sections. The median delivery gestational age was 36^(+3)week(28-38^(+5)week), median first stage duration of labor was 220 minutes(63-1 260 minutes) and median second stage duration was 41minutes(8-215 minutes). Eleven(8.8%) patients underwent forceps delivery and 4(1.4%) neonatal Apgar scores in 1 minute were less than 7(1.4%, 2 cases in vaginal-cesarean delivery). The postpartum hemorrhage rate was 16.5%(25.0% in vaginal-cesarean delivery and 17.6% in vaginal delivery). By adjusting confounding factors of gestational age, parity and neonatal weight, postpartum hemorrhage was found to be associated with longer second stage of labor(P=0.01), and the duration of the second stage was positively correlated with the amount of postpartum hemorrhage without statistical difference(P=0.28). After adjusting confounding factors of parity, prepregnant BMI, gestational age and neonatal weight between spontaneous onset and induced groups, there were no statistical differences in maternal and fetal outcomes, including cesarean rate, amount and rate of postpartum hemorrhage, labor duration, forceps delivery rate, lateral episiotomy rate, third-and fourth-degree perineal tears,Apgar score in 1 minute between the two groups. Conclusio

关 键 词：双胎 阴道试产 母儿结局 产程 产后出血 复合分娩 

分 类 号：R714.23[医药卫生—妇产科学]