【摘要】 目的分析双胎妊娠分娩方式及分娩顺序对新生儿窒息发生的影响。方法回顾性分析2010年1月至2018年12月在复旦大学附属妇产科医院分娩的2 035例产妇及4 070例双胎新生儿的临床资料,将产妇和双胎新生儿按分娩方式分为阴道分娩组(97例,194例)与剖宫产组(1 938例,3 876例),分析分娩方式及分娩顺序对双胎新生儿窒息的影响。结果在2 035例产妇中,平均年龄(31.83±4.44)岁,平均分娩孕周(35.23±2.19)周;新生儿平均出生体重(2 327.84±486.11)g,双胎之大平均出生体重(2 248.64±484.03)g,双胎之小平均出生体重(2 307.03±478.42)g。阴道分娩组新生儿胎龄和出生体重均显著低于剖宫产组(t值分别为4.464、7.007),新生儿窒息发生率显著高于剖宫产组(χ~2=15.705),差异均有统计学意义(P<0.05)。阴道分娩组产妇的妊娠期高血压疾病、子痫或子痫前期、胎儿宫内窘迫、胎膜早破、胎盘异常的发生率与剖宫产组比较,差异均有统计学意义(χ~2值分别为9.448、11.683、5.681、13.858、6.780,P<0.05)。在4 070例双胎新生儿中发生窒息211例,窒息率占5.18%。在调整双胎新生儿胎龄、出生体重及产妇妊娠期合并症等混杂因素后,经多因素Logistic回归分析显示,双胎新生儿经阴道分娩的窒息风险高于经剖宫产分娩(OR=1.734,95%CI:1.051～2.861,P<0.05)。结论阴道分娩比剖宫产分娩的双胎新生儿窒息风险可能性高,临床需充分做好新生儿复苏准备工作。更多还原

【Abstract】 Objective To study relationships of delivery mode and birth order of twin pregnancy with neonatal asphyxia.Methods Clinical data of 2035 twin pregnant women and their 4 070 twin neonates who delivered and gave birth in The Affiliated Obstetrical and Gynecological Hospital of Fudan University from January 2010 to December 2018 were retrospectively analyzed.The pregnant women and their twin neonates were divided into vaginal delivery group and cesarean section group according to delivery mode, and relationships of delivery mode and birth order with incidence of neonatal asphyxia were analyzed.Results The average age of 2035 twin pregnant women at delivery was(31.83±4.44) years old, the average gestational age was(35.23±2.19) weeks, and the average birth weight of the newborns was 2 327.84 ±486.11 g [the average birth weight of the first twin was(2 248.64±484.03)g and that of the second twin was(2 307.03±478.42)g].The gestational age and birth weight in the vaginal delivery group were shorter and lower than those in the cesarean section group, there were statistically significant differences(t=4.464 and 7.007 respectively, both P<0.05).The incidence of neonatal asphyxia in the vaginal delivery group was significantly higher than that in the cesarean section group, and the difference was significant(χ~2=15.705,P<0.05).The incidences of hypertensive disorder complicating pregnancy(HDCP),eclampsia or pre-eclampsia, fetal distress, premature rupture of fetal membranes(PROM) and placental abnormalities in the vaginal delivery group were all signicantly higher than those in the cesarean section group, there were significant differences between the two groups(t=9.448,11.683,5.681,13.858 and 6.780 respectively, all P<0.05).211/4 070 twin neonates developed neonatal asphyxia, the incidence rate was 5.18%.After adjusting confounding factors such as gestational age, birth weight of the twin neonates and pregnancy complications of the pregnant women, multivariate logic regression analysis showed that the risk of asphyxia of the twin neonates in the vaginal delivery group was higher than that in cesarean section group(OR= 1.734,95%CI:1.051-2.861,P<0.05).Conclusion The risk of neonatal asphyxia in vaginal delivery is likely higher than that in cesarean section.Preparations of resuscitation for the neonates are required.更多还原