2 872对不同绒毛膜性双胎子代不良结局差异及影响因素分析  

Research on outcomes of 2 872 twins with different chorionicity and their influencing factors

作　　者：张璐[1] 杨惠娟[1] 刘凯波[1] ZHANG Lu;YANG Huijuan;LIU Kaibo(Beijing Obstetrics and Gynecology Hospital/Beijing Maternal and Child Health Care Hospital,Capital Medical University,Beijing,100026 China)

机构地区：[1]首都医科大学附属北京妇产医院/北京妇幼保健院围产保健科,100026

出　　处：《中国生育健康杂志》2023年第3期228-233,共6页Chinese Journal of Reproductive Health

基　　金：首都卫生发展科研专项(2018-2-2111)。

摘　　要：目的探讨不同绒毛膜性双胎子代不良结局发生的差异及其影响因素。方法选择2020年1月1日至12月31日,北京市妇幼保健网络信息系统中登记的2872例双胎妊娠孕妇及其子代为研究对象,所有孕妇均进行了早孕期绒毛膜性超声确认,并有明确妊娠结局。根据超声提示的双胎绒毛膜性将孕妇分为单绒毛膜双胎妊娠组(单绒组,n=642)和双绒毛膜双胎妊娠组(双绒组,n=2230)。比较单绒组和双绒组子代不良结局(<28周流产、围产期死亡、双胎均死亡和出生缺陷等)的差异,对影响单绒组和双绒组子代不良结局差异的影响因素进行多因素分析。结果单绒组和双绒组子代发生<28周流产率(分别为15.0%、9.0%,OR=1.85,95%CI:1.50~2.27)、围产期死亡率(分别为1.0%、0.4%,OR=3.22,95%CI:1.45~7.12)和双胎均死亡率(分别为12.0%、4.6%,OR=2.71,95%CI:1.91~3.83)的风险高于双绒组子代;子代不同孕周死亡风险由高到低依次为孕14~27周、孕14周前、孕28~33周和孕≥34周,单绒组子代死亡风险均高于双绒组。单绒组子代出生缺陷发生风险高于双绒组但差异无统计学意义(7.3%比6.7%,OR=1.04,95%CI:0.80~1.35)。结论单绒双胎妊娠在子代流产、围产期死亡和双胎均死亡的风险均高于双绒双胎妊娠,早孕期开始超声筛查确定绒毛膜性、中孕期加强定期检查和胎儿畸形筛查、晚孕期持续加强对每一个胎儿的关注并适时终止妊娠,对于改善双胎子代结局有积极意义。Objective To compare the outcomes of twin pregnancies according to chorionicity,and explore potential factors associated with the outcomes.Methods A total of 2872 twin pregnancies during January 1,2020 and December 31,2020 were identified from the Beijing Maternal and Child Health Information Network System,and the chorionicity of these twins were determined during the first-trimester ultrasound examination,including 642 pairs of monochorionic twins and 2230 pairs of dichorionic twins.Differences in adverse outcomes(miscarriage or fetal death<28 pregnancy weeks,perinatal death,death of both twins,and birth defects)were compared between 2 groups.Multivariate logistic regression analysis was used to explore potential factors associated with perinatal outcomes.Results The risk of miscarriage or fetal death(<28 weeks)(15.0%vs.9.0%,OR=1.85,95%CI 1.50-2.27),perinatal death(1.0%vs.0.4%,OR=3.22,95%CI 1.45-7.12),death of both twins(12.0%vs.4.6%,OR=2.71,95%CI 1.91-3.83)was significantly higher in monochorionic twins than that in dichorionic twins.The risk of death was highest during 14-27 weeks of gestation,followed by prior to 14 weeks of gestation and 28-33 weeks of gestation,and lowest at more than 34 weeks of gestation,and in all of these stages the risk of death for monochorionic twins were higher than that for dichorionic twins.The risk of birth defects was also higher in monochorionic twins than in dichorionic twins,but the difference was not statistically significant(7.3%vs.6.7%,OR=1.04,95%CI 0.80-1.35).Conclusion Monochorionic twin pregnancies were associated with increased risks of miscarriage,fetal death,perinatal death,and death of both twins than dichorionic twin pregnancies.Determination of the chorionicity of twins during the first-trimester ultrasound examination,regular check-ups and fetal malformation screening in the second trimester,continuous monitoring of each fetus in the third trimester and timely termination of pregnancy should be strengthened to improve the twin pregnancy outcomes,especially in mo

关 键 词：双胎 绒毛膜性 流产 围产期死亡 出生缺陷 

分 类 号：R71[医药卫生—妇产科学] R17[医药卫生—临床医学]