摘要
目的探讨双胎妊娠绒毛膜性对孕期及围生儿预后的影响,进而明确双胎的绒毛膜性诊断、产前管理及双胎特有并发症的处理规范。方法回顾性分析我院2011-2014年的双胎病例435例,根据绒毛膜性分为单绒毛膜双羊膜囊双胎(monochrionic diamniotic twin,MCDA)和双绒毛膜双羊膜囊双胎(dichorionic diamniotic twin,DCDA)2组,对其孕期并发症、畸形发病率、分娩孕周和新生儿体重及预后等进行分析。结果 MCDA组的自然受孕率和胎儿畸形率(84.38%、7.03%)明显高于DCDA组(38.76%、3.91%,P均<0.05),差异有统计学意义。MCDA组分娩孕周明显小于DCDA组(33.17±5.25 vs.35.39±3.32,P<0.001),其急诊剖宫产率明显高于DCDA组[36.19%(38/105)vs.19.86%(56/282),P<0.05],差异均有统计学意义。MCDA组新生儿出生体重明显小于DCDA组,新生儿的轻度、重度窒息率,流产率,胎死宫内发生率均高于DCDA组。生后死亡及死产率发生例数较少,暂无可比性。MCDA组特殊并发症的发生率明显高于DCDA组。结论双胎妊娠的绒毛膜性判断对于双胎的产前管理及预后可起到关键作用,双胎特殊并发症由于发病机制的不完全明确,其管理及治疗还需要不断总结并个性化指导及治疗。
Objective To summarize and analyze the diagnosis of double fetal chorionic, prenatal management and the treatment of the complex twins with pregnancy. Methods This study summarized the cases in Beijing Obstetrics and Gynecology Hospital from 2011 to 2014. According to the characteristics of chorioncity, patients were divided into four groups. The differences in the incidence of complications during pregnancy, the incidence of abnormal pregnancy, gestational age and birth weight of newborns were compared. Further study was carried on the pathogenesis of complex twins. Results The ratio of natural pregnancy to monochrionic diamniotic twins（MCDA） was significantly higher than dichorionic diamniotic twin（DCDA, 84.38% vs. 38.76%）. The incidence of fetal malformation rate of MCDA was significantly higher than that of DCDA（7.03% vs. 3.91%）. The difference in gestational week of MCDA and DCDA was significant（33.17±5.25 vs.35.39±3.32,P〈 0.001）. Neonatal birth weight was significantly less than DCDA in MCDA. The neonates with asphyxia rate, abortion rate and fetal death rate of MCDA were all higher than DCDA. After birth, death and death rate occurred in fewer cases, so no comparison was made. Conclusion The judgement of the chorionic of twin pregnancy plays a key role in the prenatal management and prognosis of twins. Because the pathogenesis of complex twins is not completely clear, its management and treatment needs further study.
出处
《北京医学》
CAS
2016年第11期1181-1184,共4页
Beijing Medical Journal
基金
北京市科委首都市民健康教育项目培育(Z131100004013010)
