中华妇产科杂志
中華婦產科雜誌
중화부산과잡지
CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
2012年
5期
337-341
,共5页
韩振艳%方群%罗艳敏%侯红瑛%陈敏玲%何志明%宋花蕾
韓振豔%方群%囉豔敏%侯紅瑛%陳敏玲%何誌明%宋花蕾
한진염%방군%라염민%후홍영%진민령%하지명%송화뢰
双生%出生体重%胎儿发育%胎儿生长迟缓
雙生%齣生體重%胎兒髮育%胎兒生長遲緩
쌍생%출생체중%태인발육%태인생장지완
Twins%Birth weight%Fetal development%Fetal growth retardation
目的 探讨双胎及出生体质量不同一性双胎(不同一性双胎)胎儿宫内生长发育的特点.方法 选择2000年1月至2010年7月在中山大学附属第一医院及2000年1月至2009年12月在附属第三医院住院分娩,有完整临床资料的双胎孕妇1010例及其2020个胎儿,以双胎胎儿间出生体质量差异≥25％为不同一性双胎的标准诊断,不同一性双胎孕妇共119例及其238个胎儿为不同一性双胎组；双胎间出生体质量差异＜25％的891例孕妇及其1782个胎儿为出生体质量同一性双胎(同一性双胎组).随机选择同期分娩的单胎孕妇4042例及其4042个胎儿作为单胎对照组.结果 (1)两组双胎的临床资料比较:不同一性双胎组的大胎出生体质量、小胎出生体质量及双胎胎儿间出生体质量差异分别为(2090±827)g、(1392±592)g及(33.9±9.3)％,同一性双胎组分别为(2408±543)g、(2191±505)g及(8.9±6.5)％,两组各项分别比较,差异均有统计学意义(P＜0.01).不同一性双胎发生率为11.78％(119/1010).与同一性双胎组相比,不同一性双胎组晚期流产率、单绒毛膜双胎所占比例较高(P＜0.05),其脐带附着异常、双胎输血综合征和妊娠期高血压疾病的发生率均明显高于同一性双胎组(P＜0.05).(2)双胎胎儿出生体质量的分布特点:①双胎妊娠的2020个胎儿中,80.05％ (1617/2020)的双胎胎儿出生体质量小于单胎对照组同孕周胎儿的第50百分位数,而23.71％(479/2020)的双胎胎儿出生体质量小于单胎对照组同孕周胎儿的第10百分位数.②从孕19周开始,总体双胎胎儿出生体质量的第50、90百分位数均低于单胎对照组同孕周胎儿出生体质量的相应百分位数；孕38周之后,单胎对照组胎儿出生体质量仍继续增长,并在孕41周时达到出生体质量中位数的最大值；而双胎胎儿出生体质量巾位数在孕38周时即达峰值,孕39周后出现下降趋势,并低于单胎对照组胎儿的第10百分位数.③不同一性双胎组中大胎与小胎的出生体质量的分布特点:65例(54.6％,65/119)大胎和1例(0.8％,1/119)小胎的出生体质量高于总体双胎胎儿出生体质量的第50百分位数；而5例(4.2％,5/119)大胎和97例(81.5％,97/119)小胎的出生体质量低于总体双胎胎儿出生体质量的第10百分位数.结论 (1)双胎胎儿的出生体质量随孕周变化及增长趋势与单胎不同,评估双胎胎儿宫内生长发育情况应采用双胎胎儿的出生体质量标准.(2)若以双胎胎儿出生体质量作为参考标准,多数的不同一性双胎中至少一胎存在宫内生长受限的情况.
目的 探討雙胎及齣生體質量不同一性雙胎(不同一性雙胎)胎兒宮內生長髮育的特點.方法 選擇2000年1月至2010年7月在中山大學附屬第一醫院及2000年1月至2009年12月在附屬第三醫院住院分娩,有完整臨床資料的雙胎孕婦1010例及其2020箇胎兒,以雙胎胎兒間齣生體質量差異≥25％為不同一性雙胎的標準診斷,不同一性雙胎孕婦共119例及其238箇胎兒為不同一性雙胎組；雙胎間齣生體質量差異＜25％的891例孕婦及其1782箇胎兒為齣生體質量同一性雙胎(同一性雙胎組).隨機選擇同期分娩的單胎孕婦4042例及其4042箇胎兒作為單胎對照組.結果 (1)兩組雙胎的臨床資料比較:不同一性雙胎組的大胎齣生體質量、小胎齣生體質量及雙胎胎兒間齣生體質量差異分彆為(2090±827)g、(1392±592)g及(33.9±9.3)％,同一性雙胎組分彆為(2408±543)g、(2191±505)g及(8.9±6.5)％,兩組各項分彆比較,差異均有統計學意義(P＜0.01).不同一性雙胎髮生率為11.78％(119/1010).與同一性雙胎組相比,不同一性雙胎組晚期流產率、單絨毛膜雙胎所佔比例較高(P＜0.05),其臍帶附著異常、雙胎輸血綜閤徵和妊娠期高血壓疾病的髮生率均明顯高于同一性雙胎組(P＜0.05).(2)雙胎胎兒齣生體質量的分佈特點:①雙胎妊娠的2020箇胎兒中,80.05％ (1617/2020)的雙胎胎兒齣生體質量小于單胎對照組同孕週胎兒的第50百分位數,而23.71％(479/2020)的雙胎胎兒齣生體質量小于單胎對照組同孕週胎兒的第10百分位數.②從孕19週開始,總體雙胎胎兒齣生體質量的第50、90百分位數均低于單胎對照組同孕週胎兒齣生體質量的相應百分位數；孕38週之後,單胎對照組胎兒齣生體質量仍繼續增長,併在孕41週時達到齣生體質量中位數的最大值；而雙胎胎兒齣生體質量巾位數在孕38週時即達峰值,孕39週後齣現下降趨勢,併低于單胎對照組胎兒的第10百分位數.③不同一性雙胎組中大胎與小胎的齣生體質量的分佈特點:65例(54.6％,65/119)大胎和1例(0.8％,1/119)小胎的齣生體質量高于總體雙胎胎兒齣生體質量的第50百分位數；而5例(4.2％,5/119)大胎和97例(81.5％,97/119)小胎的齣生體質量低于總體雙胎胎兒齣生體質量的第10百分位數.結論 (1)雙胎胎兒的齣生體質量隨孕週變化及增長趨勢與單胎不同,評估雙胎胎兒宮內生長髮育情況應採用雙胎胎兒的齣生體質量標準.(2)若以雙胎胎兒齣生體質量作為參攷標準,多數的不同一性雙胎中至少一胎存在宮內生長受限的情況.
목적 탐토쌍태급출생체질량불동일성쌍태(불동일성쌍태)태인궁내생장발육적특점.방법 선택2000년1월지2010년7월재중산대학부속제일의원급2000년1월지2009년12월재부속제삼의원주원분면,유완정림상자료적쌍태잉부1010례급기2020개태인,이쌍태태인간출생체질량차이≥25％위불동일성쌍태적표준진단,불동일성쌍태잉부공119례급기238개태인위불동일성쌍태조；쌍태간출생체질량차이＜25％적891례잉부급기1782개태인위출생체질량동일성쌍태(동일성쌍태조).수궤선택동기분면적단태잉부4042례급기4042개태인작위단태대조조.결과 (1)량조쌍태적림상자료비교:불동일성쌍태조적대태출생체질량、소태출생체질량급쌍태태인간출생체질량차이분별위(2090±827)g、(1392±592)g급(33.9±9.3)％,동일성쌍태조분별위(2408±543)g、(2191±505)g급(8.9±6.5)％,량조각항분별비교,차이균유통계학의의(P＜0.01).불동일성쌍태발생솔위11.78％(119/1010).여동일성쌍태조상비,불동일성쌍태조만기유산솔、단융모막쌍태소점비례교고(P＜0.05),기제대부착이상、쌍태수혈종합정화임신기고혈압질병적발생솔균명현고우동일성쌍태조(P＜0.05).(2)쌍태태인출생체질량적분포특점:①쌍태임신적2020개태인중,80.05％ (1617/2020)적쌍태태인출생체질량소우단태대조조동잉주태인적제50백분위수,이23.71％(479/2020)적쌍태태인출생체질량소우단태대조조동잉주태인적제10백분위수.②종잉19주개시,총체쌍태태인출생체질량적제50、90백분위수균저우단태대조조동잉주태인출생체질량적상응백분위수；잉38주지후,단태대조조태인출생체질량잉계속증장,병재잉41주시체도출생체질량중위수적최대치；이쌍태태인출생체질량건위수재잉38주시즉체봉치,잉39주후출현하강추세,병저우단태대조조태인적제10백분위수.③불동일성쌍태조중대태여소태적출생체질량적분포특점:65례(54.6％,65/119)대태화1례(0.8％,1/119)소태적출생체질량고우총체쌍태태인출생체질량적제50백분위수；이5례(4.2％,5/119)대태화97례(81.5％,97/119)소태적출생체질량저우총체쌍태태인출생체질량적제10백분위수.결론 (1)쌍태태인적출생체질량수잉주변화급증장추세여단태불동,평고쌍태태인궁내생장발육정황응채용쌍태태인적출생체질량표준.(2)약이쌍태태인출생체질량작위삼고표준,다수적불동일성쌍태중지소일태존재궁내생장수한적정황.
Objective To investigate the intrauterine growth characteristics of twins and birthweight discordant twins (discordant twins ).Methods Total of 1010 twin pregnancies (2020 fetuses) with complete delivery records from the Department of Obstetrics and Gynecology,the First and Third Affiliated Hospital of SUN Yat-sen University between January 1,2000 and July 31,2010 were studied retrospectively.One handred and ninteen cases (238 fetuses) with intrapair birthweight difference ≥25％ were determined as the discordant twins group,and the other 891 cases (1782 fetuses) with intrapair birthweight difference ＜ 25％ were identified as the concordant twins group.The singleton control group included 4042 singleton pregnancies in the same period.Results ( 1 ) Comparison of clinical data between the twins groups:the birthweight of larger-twin,smaller-twin and intrapair birthweight difference in the discordant twins group and the concordant twins group were ( 2090± 827 ) g,( 1392 ± 592 ) g,( 33.9 ±9.3 ) ％,and ( 2408 ± 543 ) g,( 2191 ± 505 ) g,( 8.9 ± 6.5 ) ％,respectively,with significant differences (P＜0.01).The incidence of discordant twins was 11.78％ (119/1010).Compared with the concordant twins group,the discordant twins group bad higher proportion of monochorionic twins,and higher prevalence of pregnancy complications such as late miscarriage,abnormal umbilical insertion,twin-twin transfusion syndrome and hypertensive disorders in pregnancy ( P ＜ 0.05 ).( 2 ) The characteristics of twin birthweight distribution:① In all the 2020 twins,80.05％ (1617/2020) fetuses had birthweight below the 50th percentile of the singleton control group,while 23.71％ (479/2020) feeuses got birthweight below the 10th percentile of the singleton control group.② After 19th gestational week,the 50th and 90th percentile of all twins' birthweight were lower than those of singletons.After 38th gestational week,the birthweight of singletons kept increasing and reached its peak at 41 th week,while the birthweight of twins reached its peak at 38th week,followed by a decline at 39 weeks,which was even lower than the 10th percentile of the singleton control group.③ The distribution of birthweight of larger- and smaller-twin in the discordant twins group:65 (54.6％,65/119) larger-twins and one (0.8％,1/119) smaller-twin had birthweight above the 50th percentile of all twins,while 5 (4.2％,5/119) larger-twins and 97 ( 81.5％,97/119 ) smaller-twins got birthweight below the 10th percentile of all twins.Conclusions ( 1 ) The patterns of birthweight curves for each gestational week are different between twins and singletons.In order to evaluate the growth of twins, birthweight reference for twins shoull be employed.( 2 ) According to the reference of twins birthweight,the most discordant twins are complicated with fetal growth restriction at least in one twin.
