绒毛膜性对双胎妊娠结局的影响
发布时间：2019-01-12 14:53
【摘要】：背景与目的:双胎妊娠与单胎妊娠相比,更易发生多种产科并发症,进而导致较差的妊娠结局,故双胎妊娠属于高危妊娠。近年来随着辅助生殖技术(ART)的快速发展,双胎妊娠的发生率显著升高。越来越多的报道显示单绒毛膜性(MC)双胎较双绒毛膜性(DC)双胎围产期并发症的发病率更高,且围产儿预后更差。本文通过对吉林大学第一医院不同绒毛膜性双胎妊娠的围产期并发症及母婴结局进行回顾性分析,进而探讨其临床意义。方法:1、研究资料:通过回顾性对比分析2016年1月1日至2017年1月31日期间于吉林大学第一医院住院分娩的224例双胎妊娠患者,对其绒毛膜性进行判断,并根据其绒毛膜性分为MC双胎组(单绒毛膜双羊膜囊MCDA 71例和单绒毛膜单羊膜囊MCMA 2例)73例及DC双胎组(双绒毛膜双羊膜囊DCDA)151例;分别对两组孕产妇的围产期并发症及围产儿的结局进行对比分析。2、统计学方法:采用SPSS22.0软件,对计量资料进行独立t检验,计数资料进行χ2检验。若四格表中理论频数T1,或n40则采用四格表资料的Fisher确切概率法;若1≤T5时,且n40时,则采用四格表资料χ2检验的校正公式。以上均以P0.05为差异有统计学意义。结果:1、绒毛膜性对孕产妇围产期并发症的影响:对比分析不同绒毛膜性双胎组胎膜早破(PROM)、妊娠期高血压疾病(PIH)、妊娠期糖尿病(GDM)、妊娠期肝内胆汁淤积症(ICP)、妊娠期甲状腺功能异常、妊娠期贫血、羊水过多、前置胎盘、胎盘早剥、剖宫产及产后出血等的发病率,差异无统计学意义(P0.05)。2、绒毛膜性对胎儿的影响:对比分析不同绒毛膜性双胎生长不一致、胎死宫内的发病率,MC双胎组的发病率为16.44%、6.61%,DC双胎组的发病率为6.62%、2.32%,差异有统计学意义(P0.05)。去除MC双胎中TTTS患者后,再次对比两组双胎生长不一致及胎死宫内的发病率,其统计学意义均消失(P0.05)。3、绒毛膜性对胎儿流产、新生儿早产及新生儿体重的影响:对比分析不同绒毛膜性双胎流产、早产(包括早产、早期早产、晚期早产)及新生儿体重(平均体重、低出生体重儿LBWI、超低出生体重儿VLBWI、极低出生体重儿ELBWI)之间的差异,MC双胎组的流产率、早产率(12.32%、68.49%)明显大于DC双胎组(3.97%、51.66%),差异有统计学意义(P0.05)。MC双胎组的早期早产率(32.88%)大于DC双胎组(20.53%),差异有统计学意义;MC双胎组晚期早产率(35.61%)较DC双胎组(31.13%)高,但无统计学意义(P0.05)。MC双胎组新生儿体重明显低于DC双胎组,且在LBWI、VLBWI及ELBWI的发生率上,MC双胎组均大于DC双胎组,差异有统计学意义(P0.05)。4、绒毛膜性对新生儿结局的影响:对比分析不同绒毛膜性双胎组新生儿窒息率(轻度、重度)及新生儿入住NICU率,MC双胎组的发生率较DC双胎组高,差异有统计学意义(P0.05)。5、绒毛膜性对新生儿疾病的影响:对比分析MC双胎组及DC双胎组的新生儿在持续性动脉导管未闭(PDA)、新生儿湿肺、呼吸窘迫综合症(RDS)、颅内出血、新生儿畸形、早产儿视网膜病的发病率,MC双胎组明显高于DC双胎组,差异有统计学意义(P0.05)。6、绒毛膜性对新生儿死亡率的影响:对比分析两组新生儿死亡率,MC双胎组的发病率为8.90%,DC双胎组为3.97%,差异有统计学意义(P0.05);去除MC双胎组中TTTS患者后,其统计学意义消失(P0.05)。结论:1、双胎妊娠绒毛膜性对孕产妇围产期并发症的发生无明显影响。2、单绒毛膜性双胎妊娠是发生流产、早产、早期早产、低出生体重儿、新生儿窒息及新生儿疾病的危险因素。3、单绒毛膜性双胎妊娠,其发生双胎生长不一致、胎死宫内、新生儿死亡的概率均明显高于双绒毛膜性双胎妊娠;其中单绒毛膜性双胎特有的并发症-TTTS,是以上疾病的危险因素。4、双胎妊娠绒毛膜性与围产儿的结局密切相关,单绒毛膜性双胎的围产儿结局明显差于双绒毛膜性双胎。5、妊娠早期应明确双胎妊娠绒毛膜性质,根据绒毛膜性采取不同的孕期监护;孕期加强对单绒毛膜性双胎的监护及干预,是改善双胎妊娠围产儿结局的关键。
[Abstract]:BACKGROUND & OBJECTIVE: A variety of obstetric complications are more likely to occur than a single-birth pregnancy, which in turn leads to a poor pregnancy outcome, so the twin pregnancy is a high-risk pregnancy. In recent years, with the rapid development of Assisted Reproductive Technology (ART), the incidence of twin pregnancy has increased significantly. More and more reports have shown that the incidence of a single-chorionic (MC) double-birth (MC) double-birth (DC) double-fetus perinatal complication is higher and the perinatal outcome is worse. In this paper, the perinatal complications and the mother-to-infant outcomes of different chorionic twins in the first hospital of Jilin University were analyzed retrospectively, and their clinical significance was discussed. Methods: 1. Data: 224 cases of double pregnancy were analyzed retrospectively from January 1, 2016 to January 31, 2017 in the first hospital of Jilin University. The results of the perinatal complications and the perinatal outcomes of the two groups of pregnant women were compared and analyzed according to the chorionic characteristics of the two groups (single chorionic double-amniotic sac MCDA 71 and single-chorionic single-amniotic sac MCMA) and 151 cases of DC double-birth group (double-chorionic double-amniotic sac DCDA). Statistical method: SPSS10.0 software was used to carry out the independent t test on the measurement data, and the count data was checked for the second time. If the theoretical frequency in the four-cell table is T1, or n40, the Fisher exact probability method of the four-cell table data is used; if the case is 1 to T5, and the n40 is n40, the correction formula of the four-cell table data-2 test is adopted. The difference between the two groups was P0. 05. Results: 1. The effect of chorion on the perinatal complications of the pregnant women: the early rupture (PROM), the pregnancy-induced hypertension (PIH), the gestational diabetes (GDM) and the intrahepatic cholestasis (ICP) were compared and analyzed. There was no significant difference in the incidence of thyroid function in pregnancy, anemia of pregnancy, excessive amniotic fluid, placenta, placental abruption, cesarean section and postpartum hemorrhage (P0.05). The incidence of fetal death was 16.44%, 6.61% and 6.62%, 2.32%, respectively (P <0.05). After the removal of TTS in the MC twins, the incidence of non-uniform growth of twins and the incidence of fetal death in the two groups were compared, and the statistical significance of the two groups was disappeared (P0.05). 3. The effect of chorionic on the abortion of the fetus, the premature birth of the newborn and the weight of the newborn: a comparative analysis of the different chorionic twins, The difference between the birth weight (including premature birth, early preterm birth, late-term birth), and the weight of the newborn (mean body weight, low birth weight LBWI, low birth weight VLBWI, very low birth weight, ELBWI), the rate of abortion in the MC-twin group, and the rate of premature birth (12. 32%, (68. 49%) was significantly higher than that of DC (3.97%, 51. 66%), and the difference was statistically significant (P <0.05). The early preterm birth rate (32.88%) in the MC-twins group was greater than that of the DC double-tire group (20.53%), and the difference was statistically significant; and the late-birth rate (35. 61%) in the MC-twins group was higher than that of the DC double-tire group (31.3%). But there was no statistical significance (P0.05). The weight of the newborn was significantly lower than that of the DC double-tire group, and the incidence of LBWI, VLBWI and ELBWI was higher than that of the DC double-tire group. The difference was statistically significant (P0.05). In contrast, the rate of neonatal asphyxia (mild, severe) and the rate of NICU in the newborn with different chorionic twins (mild and severe) and the rate of NICU in the newborn were compared. The incidence of the two groups in the MC was higher than that of the DC and the difference was significant (P0.05). The incidence of neonatal wet lung, respiratory distress syndrome (RDS), intracranial hemorrhage, neonatal malformations, retinopathy of prematurity and the incidence of retinopathy in premature infants were compared and analyzed. The difference was statistically significant (P0.05). 6. The effect of chorionic on the mortality of the newborn: The incidence of neonatal mortality in the two groups was compared with that of the two groups. The incidence of the two groups was 8.90% and that of the DC double-birth group was 3.97%, and the difference was statistically significant (P0.05); and after the TTS patients in the MC double-pregnancy group were removed, The statistical significance disappeared (P0.05). Conclusion: 1. There is no significant effect on the occurrence of perinatal complications of the pregnant and pregnant women in the first and the second pregnancy, and the single-chorionic double-pregnancy is a risk factor for the occurrence of abortion, premature birth, early preterm birth, low birth weight, neonatal asphyxia and neonatal disease. The single-chorionic double-pregnancy is not consistent with the twin-fetal growth, and the probability of fetal death and neonatal death is higher than that of the double-chorionic double-pregnancy, and the specific complication-TTTS of the single-chorionic double-pregnancy is the risk factor of the above-mentioned diseases. The results of the double-pregnancy were closely related to the perinatal outcome, and the perinatal outcome of the single chorionic twins was significantly worse than that of the double-chorionic twins. The strengthening of the monitoring and intervention of the single-chorionic twins during pregnancy is the key to the improvement of the perinatal outcome of the twin pregnancy.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.23
本文编号：2407903
[Abstract]:BACKGROUND & OBJECTIVE: A variety of obstetric complications are more likely to occur than a single-birth pregnancy, which in turn leads to a poor pregnancy outcome, so the twin pregnancy is a high-risk pregnancy. In recent years, with the rapid development of Assisted Reproductive Technology (ART), the incidence of twin pregnancy has increased significantly. More and more reports have shown that the incidence of a single-chorionic (MC) double-birth (MC) double-birth (DC) double-fetus perinatal complication is higher and the perinatal outcome is worse. In this paper, the perinatal complications and the mother-to-infant outcomes of different chorionic twins in the first hospital of Jilin University were analyzed retrospectively, and their clinical significance was discussed. Methods: 1. Data: 224 cases of double pregnancy were analyzed retrospectively from January 1, 2016 to January 31, 2017 in the first hospital of Jilin University. The results of the perinatal complications and the perinatal outcomes of the two groups of pregnant women were compared and analyzed according to the chorionic characteristics of the two groups (single chorionic double-amniotic sac MCDA 71 and single-chorionic single-amniotic sac MCMA) and 151 cases of DC double-birth group (double-chorionic double-amniotic sac DCDA). Statistical method: SPSS10.0 software was used to carry out the independent t test on the measurement data, and the count data was checked for the second time. If the theoretical frequency in the four-cell table is T1, or n40, the Fisher exact probability method of the four-cell table data is used; if the case is 1 to T5, and the n40 is n40, the correction formula of the four-cell table data-2 test is adopted. The difference between the two groups was P0. 05. Results: 1. The effect of chorion on the perinatal complications of the pregnant women: the early rupture (PROM), the pregnancy-induced hypertension (PIH), the gestational diabetes (GDM) and the intrahepatic cholestasis (ICP) were compared and analyzed. There was no significant difference in the incidence of thyroid function in pregnancy, anemia of pregnancy, excessive amniotic fluid, placenta, placental abruption, cesarean section and postpartum hemorrhage (P0.05). The incidence of fetal death was 16.44%, 6.61% and 6.62%, 2.32%, respectively (P <0.05). After the removal of TTS in the MC twins, the incidence of non-uniform growth of twins and the incidence of fetal death in the two groups were compared, and the statistical significance of the two groups was disappeared (P0.05). 3. The effect of chorionic on the abortion of the fetus, the premature birth of the newborn and the weight of the newborn: a comparative analysis of the different chorionic twins, The difference between the birth weight (including premature birth, early preterm birth, late-term birth), and the weight of the newborn (mean body weight, low birth weight LBWI, low birth weight VLBWI, very low birth weight, ELBWI), the rate of abortion in the MC-twin group, and the rate of premature birth (12. 32%, (68. 49%) was significantly higher than that of DC (3.97%, 51. 66%), and the difference was statistically significant (P <0.05). The early preterm birth rate (32.88%) in the MC-twins group was greater than that of the DC double-tire group (20.53%), and the difference was statistically significant; and the late-birth rate (35. 61%) in the MC-twins group was higher than that of the DC double-tire group (31.3%). But there was no statistical significance (P0.05). The weight of the newborn was significantly lower than that of the DC double-tire group, and the incidence of LBWI, VLBWI and ELBWI was higher than that of the DC double-tire group. The difference was statistically significant (P0.05). In contrast, the rate of neonatal asphyxia (mild, severe) and the rate of NICU in the newborn with different chorionic twins (mild and severe) and the rate of NICU in the newborn were compared. The incidence of the two groups in the MC was higher than that of the DC and the difference was significant (P0.05). The incidence of neonatal wet lung, respiratory distress syndrome (RDS), intracranial hemorrhage, neonatal malformations, retinopathy of prematurity and the incidence of retinopathy in premature infants were compared and analyzed. The difference was statistically significant (P0.05). 6. The effect of chorionic on the mortality of the newborn: The incidence of neonatal mortality in the two groups was compared with that of the two groups. The incidence of the two groups was 8.90% and that of the DC double-birth group was 3.97%, and the difference was statistically significant (P0.05); and after the TTS patients in the MC double-pregnancy group were removed, The statistical significance disappeared (P0.05). Conclusion: 1. There is no significant effect on the occurrence of perinatal complications of the pregnant and pregnant women in the first and the second pregnancy, and the single-chorionic double-pregnancy is a risk factor for the occurrence of abortion, premature birth, early preterm birth, low birth weight, neonatal asphyxia and neonatal disease. The single-chorionic double-pregnancy is not consistent with the twin-fetal growth, and the probability of fetal death and neonatal death is higher than that of the double-chorionic double-pregnancy, and the specific complication-TTTS of the single-chorionic double-pregnancy is the risk factor of the above-mentioned diseases. The results of the double-pregnancy were closely related to the perinatal outcome, and the perinatal outcome of the single chorionic twins was significantly worse than that of the double-chorionic twins. The strengthening of the monitoring and intervention of the single-chorionic twins during pregnancy is the key to the improvement of the perinatal outcome of the twin pregnancy.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.23
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