【作者】 张艳；

【导师】 董晋；

【作者基本信息】 西安医学院 ， 临床医学硕士（专业学位）， 2023， 硕士

【摘要】 研究背景与目的:近年来双胎妊娠的发生率越来越高,而早产是双胎妊娠最常见的一种并发症,也是导致新生儿窒息甚至死亡的重要原因。因此控制早产发生率、降低早产儿死亡率,改善早产儿近、远期并发症成为围产医学工作者的长期目标。本研究通过对双胎早产病例的临床资料进行回顾性分析,探讨双胎早产的高危因素及妊娠结局,为双胎早产的预测、预防及临床管理提供一定理论依据。研究资料及方法:选取西北妇女儿童医院2020年1月至2021年12月符合纳排标准的双胎产妇1048例作为研究对象。根据是否发生早产将研究对象分为早产组（909例）和对照组（139例）;将早产组按不同分娩孕周分为早期早产组(28～31⁺⁶周)、中期早产组(32～33⁺⁶周)和晚期早产组(34～36⁺⁶周)。收集双胎产妇及其新生儿的临床资料,回顾性分析双胎早产的高危因素及妊娠结局。采用SPSS 26.0软件对所收集的临床资料进行分析。结果:1.双胎妊娠早产率为86.74%（909/1048）,孕28～31⁺⁶周的早产率为3.82%（40/1048）,孕32～33⁺⁶周的早产率为6.97%（73/1048）,孕34～36⁺⁶周的早产率为75.95%（796/1048）。2.早产组平均年龄小于对照组,差异无统计学意义。早期早产组平均年龄小于晚期早产组,早期早产组年龄<25岁者占比高于晚期早产组,差异有统计学意义（P<0.05）。3.早产组孕前体重指数大于对照组,早产组孕前体重指数<18.5kg/m²者占比高于对照组,差异无统计学意义。中期早产组孕前体重指数<18.5kg/m²者占比高于晚期早产组,差异有统计学意义（P<0.05）。4.早产组孕期增重低于对照组,早产组孕期增重<15kg、单绒毛膜性者占比均高于对照组,早期早产组及中期早产组孕期增重<15kg者占比高于晚期早产组,差异有统计学意义（P<0.05）。5.早产组子痫前期、贫血、胎膜早破、胎儿生长受限、妊娠期肝内胆汁淤积症、羊水量异常、选择性胎儿生长受限的发生率均高于对照组,差异有统计学意义（P<0.05）。6.早产组绒毛膜羊膜炎的发生率高于对照组,早期早产组绒毛膜羊膜炎的发生率高于其他两组,差异有统计学意义（P<0.05）。7.早产组新生儿出生体重、1分钟Apgar评分均低于对照组,早产组新生儿转儿科率、新生儿住院天数均高于对照组,晚期早产组新生儿出生体重及1分钟Apgar评分均高于其他两组,差异有统计学意义（P<0.05）。8.早产组白细胞、葡萄糖、血纤维蛋白原值均高于对照组,早产组D-二聚体、白蛋白、总胆红素、肌酐、高密度脂蛋白值均低于对照组,差异有统计学意义（P<0.05）。早产组B族链球菌阳性者占比高于对照组,差异无统计学意义。9.早产组新生儿喂养不耐受、新生儿呼吸窘迫综合征、新生儿贫血、新生儿颅内出血、新生儿脑损伤、房间隔缺损、动脉导管未闭的发生率高于对照组,差异有统计学意义（P<0.05）。新生儿呼吸窘迫综合征、喂养不耐受、新生儿贫血、新生儿坏死性小肠结肠炎、新生儿脑损伤、新生儿视网膜病、新生儿败血症、房间隔缺损、动脉导管未闭的发生率随着孕周的增加呈下降趋势,晚期早产组的发生率低于其他两组,差异有统计学意义（P<0.05）。10.孕期增重<15kg、单绒毛膜性、子痫前期、贫血、妊娠期肝内胆汁淤积症、胎膜早破是双胎早产的独立危险因素。结论:1.孕期增重<15kg、单绒毛膜性、子痫前期、贫血、妊娠期肝内胆汁淤积症、胎膜早破是双胎早产的独立危险因素。2.年龄<25岁、学历在初中及以下会增加双胎孕妇发生孕32周前早产的风险。3.双胎妊娠发生早产的孕周主要分布在孕34～36⁺⁶周。4.有早产史的双胎孕妇容易发生孕34周前的早产。5.绒毛膜羊膜炎会增加双胎早产发生的风险,主要发生在孕32周前。6.随着孕周增加,早产儿出生体重及1分钟Apgar评分呈上升趋势,新生儿疾病发生率呈下降趋势,因此在保证母胎安全的前提下应尽量延长孕周。更多还原

【Abstract】 Background and objective:The rate of twin pregnancies has been increasing in recent years,preterm birth is one of the most common complications of twin pregnancies and a significant cause of neonatal asphyxia and even death.Therefore,controlling the incidence of preterm birth,reducing the mortality rate of preterm infants,and improving the near-term and long-term complications of preterm infants have become the long-term goals of perinatal medicine practitioners.In this study,we retrospectively analyzed the clinical data of twin preterm delivery to explore the high-risk factors and pregnancy outcomes of twin preterm delivery and provide some reference for the prediction,prevention,and clinical management of twin preterm delivery.Materials and methods:This study selected women who delivered twin babies in the Northwest Women’s and Children’s Hospital from January 2020 to December 2021.A total of 1048 cases were finally selected according to the nadir criteria.The twin parturients with premature delivery were selected as the premature delivery group（909cases）and the twin parturients with full term delivery were selected as the control group（139 cases）.The preterm birth group was divided into the early preterm birth group(28～31⁺⁶ weeks),midterm preterm birth group(32～33⁺⁶ weeks),and late preterm birth group(34～36⁺⁶ weeks)according to different gestational weeks.Clinical data of the twin parturients and newborns were collected.The high-risk factors and pregnancy outcomes for twin preterm births were retrospectively analyzed.The collected data were analyzed by the statistical software SPSS 26.0.Results:1.The preterm birth rate was 86.74%（909/1048）in twin pregnancies,3.82%（40/1048）in 28～31⁺⁶ weeks of gestation,6.97%（73/1048）in 32～33⁺⁶ weeks of gestation,and 75.95%（796/1048）in 34～36⁺⁶ weeks of gestation.2.The mean age of the preterm birth group was less than the control group;The mean age of the early preterm birth group was less than the late preterm birth group,the proportion of<25 years old in the early preterm birth group was higher than the late premature delivery group;the difference were statistically significant（P<0.05）.3.The pre-pregnancy body mass index of the preterm birth group were higher than the control group,the percentage of pre-pregnancy body mass index<18.5kg/m² in the preterm birth group were higher than the control group;The proportion of pre-pregnancy body mass index<18.5kg/m² in the midterm preterm birth group was higher than the late preterm birth group;the difference were statistically significant（P<0.05）.4.The pregnancy weight gain of the preterm birth group was lower than the control group,and the proportion of pregnancy weight gain<15kg and monochorionic in the preterm group was higher than the control group;The proportion of gestational weight gain<15kg in the early and midterm preterm group was higher than the late preterm group;the difference were statistically significant（P<0.05）.5.The incidence of preeclampsia,anemia,premature rupture of membranes,fetal growth restriction,intrahepatic cholestasis of pregnancy,abnormal amniotic fluid volume,and selective intrauterine growth restriction in the preterm birth group were higher than the control group;the differences were statistically significant（P<0.05）.6.The incidence of histological chorioamnionitis in the preterm birth group was higher than the control group;The incidence of histological chorioamnionitis in the early preterm birth group was higher than the other two groups;the difference were statistically significant（P<0.05）.7.The birth weight and 1-minute Apgar score of newborns in the preterm birth group were lower than the control group,and the rate of neonatal transfer to pediatrics and the number of days in pediatrics in the preterm birth group were higher than the control group;The neonatal birth weight and Apgar score of the late preterm birth group were higher than other two groups,the differences were statistically significant（P<0.05）.8.The leukocyte,glucose,and fibrinogen values in the preterm group were higher than the control group;D-Dimer,albumin,total bilirubin,creatinine,and high density lipoprotein values of the preterm group were lower than the control group;the differences were statistically significant（P<0.05）.The rate of positive for group B streptococci in the preterm birth group was higher than the control group;the difference was not statistically significant.9.The incidence of neonatal feeding intolerance,neonatal respiratory distress syndrome,neonatal anemia,neonatal intracranial hemorrhage,neonatal brain injury,atrial septal defect,and patent ductus arteriosus in the preterm birth group were higher than the control group;the differences were statistically significant（P<0.05）.The incidence of neonatal respiratory distress syndrome,feeding intolerance,neonatal anemia,neonatal necrotizing small bowel colitis,neonatal brain injury,neonatal retinopathy,neonatal sepsis,atrial septal defect,and patent ductus arteriosus tended to decrease with increasing weeks of gestation,the late preterm birth group was lower than the other two groups,the difference were statistically significant（P<0.05）.10.Gestational weight gain<15kg,monochorionic,preeclampsia,anemia,intrahepatic cholestasis of pregnancy,and premature rupture of membranes are independent risk factors for twin preterm birth.Conclusions:1.Gestational weight gain<15 kg,monochorionic,preeclampsia,anemia,intrahepatic cholestasis of pregnancy,and premature rupture of membranes are independent risk factors for twin preterm birth.2.Age<25 years and education at junior high school or below increase the risk of preterm delivery before 32 gestational weeks in twin pregnancies.3.The gestational weeks of preterm birth in twin pregnancies were mainly distributed in 34～36⁺⁶ weeks.4.Twin women with a history of preterm birth are likelier to have a preterm birth before 34 weeks.5.Chorioamnionitis can increase the risk of twin preterm births,mainly before the 32gestational weeks.6.With the increase of gestational weeks,the birth weight and 1-minute Apgar score of premature infants increased,and the incidence of neonatal diseases decreased.Therefore,the gestational week should be extended as long as possible in the guarantee of maternal and fetal safety.更多还原