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中华妇幼临床医学杂志(电子版) ›› 2016, Vol. 12 ›› Issue (05) : 590 -596. doi: 10.3877/cma.j.issn.1673-5250.2016.05.018

所属专题: 文献

论著

双胎妊娠早产的临床特点及早产儿结局分析
夏敏1, 杨平1, 崔伟1, 李蕾1, 王海宁2, 全仁贵2, 宋玉春2, 徐爱群2,()   
  1. 1. 264000 山东,烟台毓璜顶医院妇产科
    2. 264100 山东,滨州医学院烟台附属医院妇产科
  • 收稿日期:2016-05-11 修回日期:2016-07-20 出版日期:2016-10-01
  • 通信作者: 徐爱群

Clinical characteristics of twin pregnancy complicated with preterm birth and analysis of preterm infants′ outcomes

Min Xia1, Ping Yang1, Wei Cui1, Lei Li1, Haining Wang2, Rengui Quan2, Yuchun Song2, Aiqun Xu2,()   

  1. 1. Department of Obstetrics and Gynecology, Yuhuangding Hospital of Yantai, Yantai 264000, Shandong Province, China
    2. Department of Obstetrics and Gynecology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai 264100, Shandong Province, China
  • Received:2016-05-11 Revised:2016-07-20 Published:2016-10-01
  • Corresponding author: Aiqun Xu
  • About author:
    Corresponding author: Xu Aiqun, Email:
引用本文:

夏敏, 杨平, 崔伟, 李蕾, 王海宁, 全仁贵, 宋玉春, 徐爱群. 双胎妊娠早产的临床特点及早产儿结局分析[J]. 中华妇幼临床医学杂志(电子版), 2016, 12(05): 590-596.

Min Xia, Ping Yang, Wei Cui, Lei Li, Haining Wang, Rengui Quan, Yuchun Song, Aiqun Xu. Clinical characteristics of twin pregnancy complicated with preterm birth and analysis of preterm infants′ outcomes[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2016, 12(05): 590-596.

目的

探讨双胎妊娠早产的临床特点及早产儿结局。

方法

选择2012年1月1日至2013年12月31日,在烟台毓璜顶医院和滨州医学院烟台附属医院产科住院分娩的双胎妊娠早产(孕龄为28~36+6孕周)均活产分娩的116例孕妇及其分娩的232例早产儿(均纳入双胎组),以及单胎妊娠早产均活产分娩的441例孕妇及其分娩的441例早产儿(均纳入单胎组)的临床病历资料为研究对象。采用回顾性分析方法,统计学比较两组孕妇临床特点及其分娩早产儿的临床结局差异,以及两组不同孕龄分娩早产儿的出生体重及出生体重Z评分值差异。

结果

①两组孕妇的年龄、身高、入院体重、孕前与分娩时人体质量指数(BMI)、分娩孕龄及早产原因构成比比较,差异均无统计学意义(P>0.05)。双胎组孕妇孕期体重增加值、产前地塞米松(DEX)使用率(包括≤1个疗程DEX)及剖宫产率,均高于单胎组,入院孕龄小于单胎组,住院保胎时间长于单胎组,且差异均有统计学意义(P<0.05)。②双胎组孕妇分娩早产儿的出生体重及出生体重Z评分值较单胎组低,呼吸机使用时间较单胎组长,呼吸窘迫综合征(RDS)、肺炎、败血症、低血糖和贫血的发生率均较单胎组高,且差异均有统计学意义(P<0.05)。两组孕妇分娩早产儿的1 min与5 min Apgar评分、呼吸机使用率、低血钙发生率、平均住院天数及生后7 d内死亡率比较,差异均无统计学意义(P>0.05)。③双胎组孕龄为35~35+6孕周和36~36+6孕周孕妇分娩早产儿的出生体重和出生体重Z评分值,均较同孕龄单胎组早产儿低,且差异有统计学意义(P<0.05);在其余各孕龄阶段,两组孕妇分娩早产儿的出生体重和出生体重Z评分值比较,差异均无统计学意义(P>0.05)。

结论

双胎妊娠是导致早产的重要原因,可对早产儿造成严重危害,应重视对双胎妊娠孕妇发生早产的防治。

Objective

To study the clinical features of twin pregnancy complicated with preterm birth and outcomes of preterm infants.

Methods

A study was conducted on 116 hospitalized cases of twin pregnancy with preterm birth and their 232 alive newborns with gestational age from 28 weeks to 36+ 6 weeks (as twin pregnancy group), who delivered in Yuhuangding Hospital and Yantai Affiliated Hospital of Binzhou Medical University from 1 January 2012 to 31 December 2013.Meanwhile another 441 cases of singleton pregnancy with preterm birth and their 441 alive newborns with the same gestational age were as singleton pregnancy group. Analyzed the general clinical data of all subjects by retrospective method. Statistical compared the differences of maternal clinical characteristics and outcomes of preterm infants between two groups, also the birth weight and the mean Z scores of birth weight of different gestational ages of preterm infants between two groups.

Results

①There were no significant differences between two groups in maternal age and height, weight on admission, pre-pregnancy body mass index(BMI) and prenatal BMI, the gestational age of delivery and constituent ratios of cause of preterm birth(P>0.05). The gestational weight gain, the prenatal usage rate of dexamethasone(DEX) (≤1 courses of DEX) and the rate of cesarean section of twin pregnancy group were higher than those of singleton pregnancy group, the gestational ages on admission and hospitalization time for tocolysis of twin pregnancy group were younger and longer than those of singleton pregnancy group; and the differences were statistically significant(P<0.05). ②The birth weight and the mean Z scores of birth weight of preterm infants in twin pregnancy group were lower than those of singleton pregnancy group, the duration of ventilator use of preterm infants in twin pregnancy group was longer than that of singleton pregnancy group, and the rates of respiratory distress syndrome(RDS), pneumonitis, sepsis, hypoglycemia and anemia of preterm infants in twin pregnancy group were higher than those of singleton pregnancy group, and all the differences were statistically significant(P<0.05). There were no significant differences between two groups of preterm infants in 1- and 5-minute Apgar scores, the usage rate of ventilator, the incidence rate of hypocalcemia, the average stay of hospitalization and the mortality rate within postnatal 7 d(P>0.05). ③The birth weight and the Z score of birth weight of preterm infants with gestational age of 35-35+ 6 weeks and 36-36+ 6 weeks in twin pregnancy group were lower than those of singleton pregnancy group, and the differences were statistically significant(P<0.05). There were no significant differences between two groups of preterm infants with other gestational ages in birth weight and the Z score of birth weight(P>0.05).

Conclusions

Twin pregnancy is a significant reason for preterm birth, and results in severity harm to preterm infant.It is necessary to take effective measures to prevent and treat the preterm birth of twin pregnancy.

表1 两组孕妇临床特点比较(±s)
表2 两组孕妇分娩早产儿结局比较(±s)
表3 两组不同孕龄分娩早产儿的出生体重及出生体重Z评分值比较(±s)
组别 28~28+6孕周分娩早产儿 29~29+6孕周分娩早产儿 30~30+6孕周分娩早产儿
例数 出生体重 出生体重Z评分值 例数 出生体重 出生体重Z评分值 例数 出生体重 出生体重Z评分值
双胎组 4 1 042±164 -1.14±0.54 4 1 330±42 -0.44±0.13 4 1 316±160 -0.99±0.40
单胎组 5 1 086±120 -1.00±0.39 9 1 349±249 -0.38±0.75 9 1 748±704 0.08±1.76
t ? 0.38 0.38 ? 0.10 0.10 ? 1.01 1.01
P ? 0.720 0.720 ? 0.920 0.920 ? 0.350 0.350
组别 31~31+6孕周分娩早产儿 32~32+6孕周分娩早产儿 33~33+6孕周分娩早产儿
例数 出生体重 出生体重Z评分值 例数 出生体重 出生体重Z评分值 例数 出生体重 出生体重Z评分值
双胎组 8 1 825±104 -0.23±0.20 12 1 641±273 -0.75±0.62 22 2 040±376 -0.21±0.87
单胎组 12 1 646±297 -0.58±0.58 25 1 841±436 -0.29±0.99 62 2 045±417 -0.20±0.96
t ? -1.14 -1.14 ? 1.03 1.03 ? 0.04 0.04
P ? 0.280 0.280 ? 0.320 0.320 ? 0.970 0.970
组别 34~34+6孕周分娩早产儿 35~35+6孕周分娩早产儿 36~36+6孕周分娩早产儿
例数 出生体重 出生体重Z评分值 例数 出生体重 出生体重Z评分值 例数 出生体重 出生体重Z评分值
双胎组 18 2 043±235 -0.71±0.52 76 2 292±491 -0.65±1.19 84 2 477±361 -0.57±0.90
单胎组 71 2 344±400 -0.04±0.89 103 2 589±503 0.07±1.22 145 2 865±408 0.39±1.02
t ? 1.92 1.92 ? 2.90 2.90 ? 5.24 5.24
P ? 0.060 0.060 ? 0.005 0.005 ? 0.000 0.000
[1]
PlattMJ. Outcomes in preterm infants[J].Public Health,2014,128(5):399-403.
[2]
BlencoweH, CousensS, OestergaardMZ,et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications[J]. Lancet,2012,379(9832):2162-2172.
[3]
CollinsA, ShennanA. A clinical opinion on how to manage the risk of preterm birth in twins based on literature review[J]. J Matern Fetal Neonatal Med,2016,29(7):1125-1130.
[4]
BrickerL. Optimal antenatal care for twin and triplet pregnancy: the evidence base[J]. Best Pract Res Clin Obstet Gynaecol,2014,28(2):305-317.
[5]
MasheerS,MaheenH,MunimS. Perinatal outcome of twin pregnancies according to chorionicity: an observational study from tertiary care hospital[J]. J Matern Fetal Neonatal Med,2015,28(1):23-25.
[6]
Vuli', c)M,RojeD, MestrovićZ,et al. Is there difference in perinatal outcome of singleton and twin pregnancies after assisted conception: two-year experience[J]. Acta Clin Croat,2013,52(2):241-246.
[7]
CasertaD,BordiG,StegagnoM,et al. Maternal and perinatal outcomes in spontaneous versus assisted conception twin pregnancies[J]. Eur J Obstet Gynecol Reprod Biol,2014,174:64-69.
[8]
徐爱群,曾蔚越,何礼霞,等.多疗程糖皮质激素治疗孕34周前早产临床分析[J].实用妇产科杂志,2006,22(10):610-613.
[9]
沈晓明,王为平.儿科学.7版[M].北京:人民卫生出版社,2008:90.
[10]
VogelJP, TorloniMR, SeucA,et al. Maternal and perinatal outcomes of twin pregnancy in 23 low- and middle-income countries[J].PLoS One,2013,8(8):e70549.
[11]
SentilhesL,OppenheimerA,BouhoursAC,et al. Neonatal outcome of very preterm twins: policy of planned vaginal or cesarean delivery[J]. Am J Obstet Gynecol, 2015,213(1):73.e1-e7.
[12]
GetahunD, DemissieK, MarcellaSW,et al. The impact of changes in preterm birth among twins on stillbirth and infant mortality in the United States[J]. J Perinatol,2014,34(11):823-829.
[13]
NewnhamJP, DickinsonJE, HartRJ, et al. Strategies to prevent preterm birth[J]. Front Immunol,2014,5:584.
[14]
AnanthCV, ChauhanSP. Epidemiology of twinning in developed countries[J]. Semin Perinatol,2012,36(3):156-161.
[15]
DeclercqE, LukeB, BelanoffC,et al.Perinatal outcomes associated with assisted reproductive technology:the Massachusetts Outcomes Study of Assisted Reproductive Technologies (MOSART)[J]. Fertil Steril,2015,103(4):888-895.
[16]
Conde-AgudeloA,RomeroR. Prediction of preterm birth in twin gestations using biophysical and biochemical tests[J]. Am J Obstet Gynecol,2014,211(6):583-595.
[17]
ChauhanSP,ScardoJA,HayesE,et al. Twins: prevalence, problems, and preterm births[J]. Am J Obstet Gynecol,2010,203(4):305-315.
[18]
吴巍巍,胡连鑫,邱丽倩,等. 2008-2013年浙江省多胎发生情况及其围生期结局分析[J].中华预防医学杂志,2015,49(3):265-268.
[19]
NewmanRB,UnalER. Multiple gestations: timing of indicated late preterm and early-term births in uncomplicated dichorionic, monochorionic,and monoamniotic twins[J]. Semin Perinatol,2011,35(5):277-285.
[20]
PapiernikE,ZeitlinJ,DelmasD,et al. Differences in outcome between twins and singletons born very preterm: results from a population-based European cohort[J]. Hum Reprod,2010,25(4):1035-1043.
[21]
Kosińska-KaczyńskaK,SzymusikI,KaczyńskiB,et al. Iatrogenic and spontaneous late preterm twins-which are at higher risk of neonatal complications?[J]. Ginekol Pol,2013,84(6):430-435.
[22]
Mendez-FigueroaH,DahlkeJD,ViteriOA,et al. Neonatal and infant outcomes in twin gestations with preterm premature rupture of membranes at 24-31 weeks of gestation[J]. Obstet Gynecol,2014,124(2 Pt 1):323-331.
[23]
LisonkovaS, HutcheonJA, JosephKS.Temporal trends in neonatal outcomes following iatrogenic preterm delivery[J].BMC Pregnancy Childbirth, 2011,11(2):39.
[24]
GariteTJ, ClarkRH, ElliottJP,et al.Twins and triplets: the effect of plurality and growth on neonatal outcome compared with singleton infants[J]. Am J Obstet Gynecol,2005,191(3):700-707.
[25]
VachharajaniAJ,VachharajaniNA,DawsonJG. Comparison of short-term outcomes of late preterm singletons and multiple births: an institutional experience[J]. Clin Pediatr(Phila),2009,48(9):922-925.
[26]
RibicicR, KranjcecI, BorosakJ,et al. Perinatal outcome of singleton versus twin late preterm infants: do twins mature faster than singletons?[J]. J Matern Fetal Neonatal Med,2016,29(9):1520-1524.
[27]
GargP,Abdel-LatifME,BolisettyS,et al.Perinatal characteristics and outcome of preterm singleton,twin and triplet infants in NSW and the ACT, Australia (1994-2005)[J]. Arch Dis Child Fetal Neonatal Ed,2010,95(1):F20-F24.
[28]
RossiAC,D′AddarioV. Neonatal outcomes of assisted and naturally conceived twins:systematic review and meta-analysis[J].J Perinat Med,2011,39(5):489-493.
[29]
QaziG.Obstetric and perinatal outcome of multiple pregnancy[J].J Coll Physicians Surg Pak,2011,21(3):142-145.
[30]
PetitN,CammuH,MartensG,et al.Perinatal outcome of twins compared to singletons of the same gestational age: a case-control study[J]. Twin Res Hum Genet,2011,14(1):88-93.
[31]
Bodeau-LivinecF,ZeitlinJ,BlondelB,et al. Do very preterm twins and singletons differ in their neurodevelopment at 5 years of age?[J]. Arch Dis Child Fetal Neonatal Ed,2013,98(6):F480-F487.
[32]
van BaarenGJ,PeelenMJ,SchuitE, et al. Preterm birth in singleton and multiple pregnancies: evaluation of costs and perinatal outcomes[J].Eur J Obstet Gynecol Reprod Biol,2015,186:34-41.
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