双胎妊娠孕期规范化诊疗和管理对围产儿预后影响研究

发布时间：2018-01-14 05:23

本文关键词：双胎妊娠孕期规范化诊疗和管理对围产儿预后影响研究　出处：《中国实用妇科与产科杂志》2017年06期 　论文类型：期刊论文

【摘要】：目的探讨双胎妊娠诊治规范和管理模式建立前后双胎妊娠绒毛膜性诊断的准确性和围产儿预后的改变。方法收集2010-01-01—2015-12-31在复旦大学附属妇产科医院杨浦院区产科分娩、经产后肉眼检查或胎盘胎膜病理检查明确绒毛膜性质的双胎妊娠孕妇444例,以本院2013-06-01起对双胎妊娠实施规范化诊疗和管理(简称"规范")为界分组,比较规范实施前后绒毛膜性诊断的准确性、妊娠结局及围产儿预后方面的差异。结果 (1)规范实施前后,收集病例的年龄、身高、体重之间差异无统计学意义(P0.05)。(2)规范实施后,产前超声诊断绒毛膜性的比例较实施前明显增加(91.7%vs.70.2%,P0.01),根据超声检查孕囊个数诊断绒毛膜性的比例明显增加(71.7%vs.60.0%,P0.01);规范实施前有2例产后与产前绒毛膜性诊断不相符,规范实施后诊断均相符,但总体绒毛膜性的诊断准确率差异无统计学意义(P0.05)。(3)规范实施后的择期剖宫产分娩孕周明显晚于规范实施前[(37.17±0.45)周vs.(36.93±0.51)周,P0.01],其中双绒毛膜双胎择期剖宫产分娩孕周在规范实施后亦明显晚于规范实施前[(37.32±0.32)周vs.(37.03±0.46)周,P0.01]。(4)规范实施前后的新生儿出生体重差异无统计学意义(P0.05),母婴同室比例在规范实施后高于规范实施前(58.3%vs.54.1%,P0.05),新生儿NICU入住率、出生后直接转院比例及放弃抢救比例低于规范实施前(37.4%vs.37.7%,4.3%vs.7.3%,0 vs.0.9%,P0.05)。结论双胎妊娠诊治规范和管理模式的建立有利于围产儿预后的改善。
[Abstract]:Objective to investigate the accuracy of chorionic diagnosis of twin pregnancy and the changes of perinatal prognosis before and after the establishment of management model for twin pregnancy. Methods to collect the data from 2010-01-01-2015-12-31. Delivery of obstetrics and obstetrics in Yangpu Hospital, Fudan University affiliated Obstetrics and Gynecology Hospital. 444 cases of twin pregnancy with chorionic nature were confirmed by postpartum naked eye examination or placental membrane pathological examination. The standardized diagnosis and management of twin pregnancy (referred to as "standard") from 2013-06-01 in our hospital were divided into groups to compare the accuracy of chorionic diagnosis before and after standardization. Results there was no significant difference in age, height and weight between the collected cases before and after the implementation of the standard. Results there was no significant difference in the age, height and weight of the patients before and after the implementation of the standard. The proportion of prenatal ultrasound diagnosis of chorionic villi was significantly increased by 91.7 vs.70.2% (P0.01). According to the number of gestational sac, the proportion of diagnosis of chorionic villi was obviously increased by 71.7 vs.60.0g. Two cases of postpartum were not in accordance with prenatal chorionic diagnosis before the implementation of the standard, and all the diagnoses were consistent after the implementation of the standard. However, there was no significant difference in the diagnostic accuracy of total chorionic villi. (P0.05. 3) the gestational weeks of elective cesarean section after the implementation of the norms were significantly later than those before the implementation of the norms. [Vs.(36.93 卤0.51 weeks (P 0.01). The gestational weeks of elective cesarean section for twin chorionic twins were also significantly later than those before the implementation of the standard. [There was no significant difference in neonatal birth weight before and after the implementation of the standard (vs.(37.03 卤0.46) weeks (P0.01). There was no significant difference in birth weight between the two groups before and after the implementation of the standard (P0.05). The proportion of mother and child in the same room was higher than that before the standard implementation (58.3vs.54.1), and the occupancy rate of neonatal NICU was higher than that of the control group (P0.05). The proportion of direct transfer after birth and the proportion of giving up rescue were lower than that before the implementation of the norm. The proportion of 4.3vs.7.3vs.7.3vs.0.9%. Conclusion the diagnosis and treatment of twin pregnancy and the establishment of management model are beneficial to the improvement of perinatal prognosis.
【作者单位】：复旦大学附属妇产科医院产科;中国医科大学附属盛京医院产科;
【基金】：国家卫计委公益性行业科研专项项目(201402006) 中国双胎和胎儿结构异常协作组
【分类号】：R714.23
【正文快照】： 自20世纪80年代起,发达国家双胎发生率显著上升,从1980年至2009年,美国的双胎出生率从1.89%上升至3.33%[1]。这主要由以下两方面原因引起:(1)由于推迟生育,孕妇年龄逐渐增加。(2)辅助生殖技术及促排卵药物使用的增多。我国双胎发生率亦呈上升趋势,采取辅助生殖技术妊娠的病例

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