CAJ | 학술논문

目的探讨双胎妊娠胎儿发育不均衡的临床特点及预后.方法回顾性分析2000年1月1日至2012年7月31日在北京大学第一医院产科分娩的576例双胎妊娠孕妇(除外双胎输血综合征病例)资料.根据胎儿腹围以及股骨长估计胎儿体重,分娩后记录新生儿出生体重,根据公式[(较大儿体重-较小儿体重)/较大儿体重×100％]计算双胎体重的差异,体重差异≥25％考虑存在胎儿发育不均衡,＜25％为胎儿发育均衡.分析双胎妊娠胎儿发育不均衡的发生率;比较胎儿发育不均衡者(不均衡组,68例)与胎儿发育均衡者(均衡组,508例)的母体并发症(子痫前期、胎膜早破、妊娠期糖尿病、产后出血等)发生率、早产率、围产儿病死率、新生儿出生体重和新生儿合并症(心血管系统疾病和颅内病变)发生率.统计学分析采用t检验或卡方检验. 结果 576例双胎妊娠中,胎儿发育不均衡总体发生率为11.8％(68/576).单绒毛膜双胎胎儿发育不均衡发生率[17.6％(40/227)]高于双绒毛膜双胎[8.0％(28/349)],差异有统计学意义(x2=11.40,P＜0.05).胎儿发育不均衡组分娩孕周小于均衡组[(35.6±4.1)周与(36.6±3.2)周,t=1.66,P＜0.05],早产率高于均衡组[58.8％(40/68)与47.6％ (242/508),x2=3.85,P＜0.05].不均衡组围产儿病死率高于均衡组[9.6％(1 3/136)与4.7％ (48/1 016),x2=5.84,P＜0.05].胎儿发育不均衡者中,单绒毛膜双胎妊娠新生儿颅内病变的发生率明显高于双绒毛膜双胎组[20.9％(14/67)与6.8％(3/44),x2=4.06,P＜0.05].结论双胎妊娠胎儿发育不均衡孕妇较易发生不良妊娠结局.应加强产前保健,并及时评估胎儿的宫内状况,分娩后建议对新生儿进行全面检查并长期随访.
목적 탐토쌍태임신태인발육불균형적림상특점급예후.방법 회고성분석2000년1월1일지2012년7월31일재북경대학제일의원산과분면적576례쌍태임신잉부(제외쌍태수혈종합정병례)자료.근거태인복위이급고골장고계태인체중,분면후기록신생인출생체중,근거공식[(교대인체중-교소인체중)/교대인체중×100％]계산쌍태체중적차이,체중차이≥25％고필존재태인발육불균형,＜25％위태인발육균형.분석쌍태임신태인발육불균형적발생솔;비교태인발육불균형자(불균형조,68례)여태인발육균형자(균형조,508례)적모체병발증(자간전기、태막조파、임신기당뇨병、산후출혈등)발생솔、조산솔、위산인병사솔、신생인출생체중화신생인합병증(심혈관계통질병화로내병변)발생솔.통계학분석채용t검험혹잡방검험. 결과 576례쌍태임신중,태인발육불균형총체발생솔위11.8％(68/576).단융모막쌍태태인발육불균형발생솔[17.6％(40/227)]고우쌍융모막쌍태[8.0％(28/349)],차이유통계학의의(x2=11.40,P＜0.05).태인발육불균형조분면잉주소우균형조[(35.6±4.1)주여(36.6±3.2)주,t=1.66,P＜0.05],조산솔고우균형조[58.8％(40/68)여47.6％ (242/508),x2=3.85,P＜0.05].불균형조위산인병사솔고우균형조[9.6％(1 3/136)여4.7％ (48/1 016),x2=5.84,P＜0.05].태인발육불균형자중,단융모막쌍태임신신생인로내병변적발생솔명현고우쌍융모막쌍태조[20.9％(14/67)여6.8％(3/44),x2=4.06,P＜0.05].결론 쌍태임신태인발육불균형잉부교역발생불량임신결국.응가강산전보건,병급시평고태인적궁내상황,분면후건의대신생인진행전면검사병장기수방.
Objective To investigate clinical characteristics and outcomes of twin pregnancies complicated with growth discordance.Methods Five hundred and seventy-six twin pregnancies who delivered between January 1,2000 and July 31,2012 in Peking University First Hospital were retrospectively analyzed.Cases with twin-twin transfusion syndrome had been excluded.Fetal weight was estimated by abdominal circumference and femur length; neonatal birth weight was recorded.The weight difference between two babies was divided by the weight of the bigger one to obtain the differential ratio.Twin pregnancy complicated with growth discordance was diagnosed if the ratio was equal or greater than 25％ (discordance group,n=68),and growth concordance was diagnosed if the ratio was less than 25％ (concordance group,n=508).The incidence of twin pregnancies complicated with growth discordance was analyzed.The incidence of maternal complications,premature delivery,perinatal death and neonatal complications were compared between the two groups.Chisquare test and t test were used for statistical analysis.Results The incidence of twin pregnancies complicated with growth discordance was 11.8％ (68/576).The incidence of growth discordance in monochorionic twins was higher than that in dichorionic twins [17.6％ (40/227) vs 8.0％ (28/349),x2=11.40,P＜0.05].The gestational age at delivery in the discordance group was earlier than that in the concordance group [(35.6±4.1) weeks vs (36.6±3.2) weeks,t=-1.66,P＜0.05],and the incidence of premature delivery in the discordance group was higher than that in the concordance group [58.8％ (40/68) vs 47.6％ (242/508),x2=3.85,P＜0.05].The perinatal mortality in discordance group was higher than that in the concordance group [9.6％ (13/136) vs 4.7％ (48/1 016),x2=5.84,P＜0.05].Among babies in discordance group,the incidence of intracranial lesion in monochorionic twins was higher than that in dichorionic twins [20.9％ (14/67) vs 6.8％ (3/44),x2=4.06,P＜0.05].Conclusions Twin pregnancies with growth discordance are prone to adverse pregnancy outcomes.Prenatal care should be strengthened and fetal condition should be assessed timely.It is suggested that neonates should undergo overall checkup and long-term follow-up.