【摘要】：背景與目的:雙胎妊娠與單胎妊娠相比,更易發(fā)生多種產(chǎn)科并發(fā)癥,進(jìn)而導(dǎo)致較差的妊娠結(jié)局,故雙胎妊娠屬于高危妊娠。近年來隨著輔助生殖技術(shù)(ART)的快速發(fā)展,雙胎妊娠的發(fā)生率顯著升高。越來越多的報道顯示單絨毛膜性(MC)雙胎較雙絨毛膜性(DC)雙胎圍產(chǎn)期并發(fā)癥的發(fā)病率更高,且圍產(chǎn)兒預(yù)后更差。本文通過對吉林大學(xué)第一醫(yī)院不同絨毛膜性雙胎妊娠的圍產(chǎn)期并發(fā)癥及母嬰結(jié)局進(jìn)行回顧性分析,進(jìn)而探討其臨床意義。方法:1、研究資料:通過回顧性對比分析2016年1月1日至2017年1月31日期間于吉林大學(xué)第一醫(yī)院住院分娩的224例雙胎妊娠患者,對其絨毛膜性進(jìn)行判斷,并根據(jù)其絨毛膜性分為MC雙胎組(單絨毛膜雙羊膜囊MCDA 71例和單絨毛膜單羊膜囊MCMA 2例)73例及DC雙胎組(雙絨毛膜雙羊膜囊DCDA)151例;分別對兩組孕產(chǎn)婦的圍產(chǎn)期并發(fā)癥及圍產(chǎn)兒的結(jié)局進(jìn)行對比分析。2、統(tǒng)計學(xué)方法:采用SPSS22.0軟件,對計量資料進(jìn)行獨立t檢驗,計數(shù)資料進(jìn)行χ2檢驗。若四格表中理論頻數(shù)T1,或n40則采用四格表資料的Fisher確切概率法;若1≤T5時,且n40時,則采用四格表資料χ2檢驗的校正公式。以上均以P0.05為差異有統(tǒng)計學(xué)意義。結(jié)果:1、絨毛膜性對孕產(chǎn)婦圍產(chǎn)期并發(fā)癥的影響:對比分析不同絨毛膜性雙胎組胎膜早破(PROM)、妊娠期高血壓疾病(PIH)、妊娠期糖尿病(GDM)、妊娠期肝內(nèi)膽汁淤積癥(ICP)、妊娠期甲狀腺功能異常、妊娠期貧血、羊水過多、前置胎盤、胎盤早剝、剖宮產(chǎn)及產(chǎn)后出血等的發(fā)病率,差異無統(tǒng)計學(xué)意義(P0.05)。2、絨毛膜性對胎兒的影響:對比分析不同絨毛膜性雙胎生長不一致、胎死宮內(nèi)的發(fā)病率,MC雙胎組的發(fā)病率為16.44%、6.61%,DC雙胎組的發(fā)病率為6.62%、2.32%,差異有統(tǒng)計學(xué)意義(P0.05)。去除MC雙胎中TTTS患者后,再次對比兩組雙胎生長不一致及胎死宮內(nèi)的發(fā)病率,其統(tǒng)計學(xué)意義均消失(P0.05)。3、絨毛膜性對胎兒流產(chǎn)、新生兒早產(chǎn)及新生兒體重的影響:對比分析不同絨毛膜性雙胎流產(chǎn)、早產(chǎn)(包括早產(chǎn)、早期早產(chǎn)、晚期早產(chǎn))及新生兒體重(平均體重、低出生體重兒LBWI、超低出生體重兒VLBWI、極低出生體重兒ELBWI)之間的差異,MC雙胎組的流產(chǎn)率、早產(chǎn)率(12.32%、68.49%)明顯大于DC雙胎組(3.97%、51.66%),差異有統(tǒng)計學(xué)意義(P0.05)。MC雙胎組的早期早產(chǎn)率(32.88%)大于DC雙胎組(20.53%),差異有統(tǒng)計學(xué)意義;MC雙胎組晚期早產(chǎn)率(35.61%)較DC雙胎組(31.13%)高,但無統(tǒng)計學(xué)意義(P0.05)。MC雙胎組新生兒體重明顯低于DC雙胎組,且在LBWI、VLBWI及ELBWI的發(fā)生率上,MC雙胎組均大于DC雙胎組,差異有統(tǒng)計學(xué)意義(P0.05)。4、絨毛膜性對新生兒結(jié)局的影響:對比分析不同絨毛膜性雙胎組新生兒窒息率(輕度、重度)及新生兒入住NICU率,MC雙胎組的發(fā)生率較DC雙胎組高,差異有統(tǒng)計學(xué)意義(P0.05)。5、絨毛膜性對新生兒疾病的影響:對比分析MC雙胎組及DC雙胎組的新生兒在持續(xù)性動脈導(dǎo)管未閉(PDA)、新生兒濕肺、呼吸窘迫綜合癥(RDS)、顱內(nèi)出血、新生兒畸形、早產(chǎn)兒視網(wǎng)膜病的發(fā)病率,MC雙胎組明顯高于DC雙胎組,差異有統(tǒng)計學(xué)意義(P0.05)。6、絨毛膜性對新生兒死亡率的影響:對比分析兩組新生兒死亡率,MC雙胎組的發(fā)病率為8.90%,DC雙胎組為3.97%,差異有統(tǒng)計學(xué)意義(P0.05);去除MC雙胎組中TTTS患者后,其統(tǒng)計學(xué)意義消失(P0.05)。結(jié)論:1、雙胎妊娠絨毛膜性對孕產(chǎn)婦圍產(chǎn)期并發(fā)癥的發(fā)生無明顯影響。2、單絨毛膜性雙胎妊娠是發(fā)生流產(chǎn)、早產(chǎn)、早期早產(chǎn)、低出生體重兒、新生兒窒息及新生兒疾病的危險因素。3、單絨毛膜性雙胎妊娠,其發(fā)生雙胎生長不一致、胎死宮內(nèi)、新生兒死亡的概率均明顯高于雙絨毛膜性雙胎妊娠;其中單絨毛膜性雙胎特有的并發(fā)癥-TTTS,是以上疾病的危險因素。4、雙胎妊娠絨毛膜性與圍產(chǎn)兒的結(jié)局密切相關(guān),單絨毛膜性雙胎的圍產(chǎn)兒結(jié)局明顯差于雙絨毛膜性雙胎。5、妊娠早期應(yīng)明確雙胎妊娠絨毛膜性質(zhì),根據(jù)絨毛膜性采取不同的孕期監(jiān)護(hù);孕期加強對單絨毛膜性雙胎的監(jiān)護(hù)及干預(yù),是改善雙胎妊娠圍產(chǎn)兒結(jié)局的關(guān)鍵。
[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.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R714.23

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 焦福蘭,劉志蓉,張雪瓊,劉紅;雙胎妊娠之一侵蝕性葡萄胎肺轉(zhuǎn)移一例[J];中華婦產(chǎn)科雜志;2003年12期

2 朱曉明;;超聲預(yù)測雙胎妊娠出生體重差異[J];世界核心醫(yī)學(xué)期刊文摘(婦產(chǎn)科學(xué)分冊);2006年10期

3 李春華;;雙胎妊娠的臨床分析與處理[J];中外醫(yī)療;2010年04期

4 樊晶;;雙胎妊娠中的有創(chuàng)診斷程序[J];中國產(chǎn)前診斷雜志(電子版);2010年02期

5 吳曉云;30例雙胎妊娠分娩中監(jiān)護(hù)的體會[J];中國基層醫(yī)學(xué);1995年S1期

6 初虹,崔順喜,許蓮花;雙胎妊娠誤診為單胎妊娠1例[J];現(xiàn)代中西醫(yī)結(jié)合雜志;1998年02期

7 楊曉萍,許淑金;1例雙胎妊娠紙樣兒報告[J];黑龍江護(hù)理雜志;1999年07期

8 王玉梅;雙胎妊娠臍帶互結(jié)成袢1例[J];中國實用婦科與產(chǎn)科雜志;2000年04期

9 王金仙,林峰;一側(cè)宮角雙胎妊娠術(shù)前診斷一例[J];中華婦產(chǎn)科雜志;2000年07期

10 楊峰;雙胎妊娠分娩方式41例分析[J];重慶醫(yī)學(xué);2000年01期

相關(guān)會議論文 前10條

1 張喻;穆世剛;安培麗;;異常雙胎妊娠的超聲診斷[A];第九屆全國超聲醫(yī)學(xué)學(xué)術(shù)會議論文匯編[C];2006年

2 任雪娟;;雙胎妊娠89例臨床分析[A];首屆滬浙婦產(chǎn)科學(xué)術(shù)論壇暨2006年浙江省婦產(chǎn)科學(xué)學(xué)術(shù)年會論文匯編[C];2006年

3 黃引平;;雙胎妊娠中的特殊并發(fā)癥及臨床診治[A];2009年浙江省圍產(chǎn)醫(yī)學(xué)學(xué)術(shù)年會暨“圍產(chǎn)醫(yī)學(xué)熱點問題”專題學(xué)術(shù)論壇論文匯編[C];2009年

4 程瑩;;86例雙胎妊娠的臨床分析[A];紀(jì)念卓越的人民醫(yī)學(xué)家林巧稚大夫誕辰100周年——全國婦產(chǎn)科高級學(xué)術(shù)論壇論文集[C];2001年

5 施靜芳;趙欣;;雙胎妊娠102例臨床分析[A];中華醫(yī)學(xué)會第二次全國產(chǎn)科熱點問題研討會及第一屆全國產(chǎn)科主任論壇學(xué)術(shù)會議論文匯編[C];2004年

6 施錚錚;朱華;周凱;;雙胎妊娠一胎死亡13例臨床分析[A];首屆滬浙婦產(chǎn)科學(xué)術(shù)論壇暨2006年浙江省婦產(chǎn)科學(xué)學(xué)術(shù)年會論文匯編[C];2006年

7 黃引平;;雙胎妊娠的規(guī)范監(jiān)測和處理[A];中華醫(yī)學(xué)會第十次全國婦產(chǎn)科學(xué)術(shù)會議產(chǎn)科會場（產(chǎn)科學(xué)組、妊高癥學(xué)組）論文匯編[C];2012年

8 劉超斌;易勁松;盧芳;王梅英;;雙胎妊娠并發(fā)妊娠高血壓綜合征67例分析[A];紀(jì)念卓越的人民醫(yī)學(xué)家林巧稚大夫誕辰100周年——全國婦產(chǎn)科高級學(xué)術(shù)論壇論文集[C];2001年

9 劉超斌;易勁松;盧芳;王梅英;;雙胎妊娠并發(fā)妊高征67例分析[A];紀(jì)念卓越的人民醫(yī)學(xué)家林巧稚大夫誕辰100周年——全國婦產(chǎn)科高級學(xué)術(shù)論壇論文集[C];2001年

10 梁愛蘭;;155例雙胎妊娠孕晚期并發(fā)癥分析[A];全國婦產(chǎn)科護(hù)理學(xué)術(shù)交流暨專題講座會議論文匯編[C];2006年

相關(guān)重要報紙文章 前3條

1 胡興肖;診治恰當(dāng) 雙胎妊娠有驚無險[N];農(nóng)村醫(yī)藥報（漢）;2008年

2 周光洪;懷了雙胞胎應(yīng)注意什么[N];衛(wèi)生與生活報;2007年

3 劉新暉;多胎多福嗎？[N];大眾衛(wèi)生報;2007年

相關(guān)碩士學(xué)位論文 前10條

1 陶志云;雙胎妊娠對子宮牽張力影響的研究[D];安徽醫(yī)科大學(xué);2015年

2 朱婷;雙胎妊娠絨毛膜性對母兒結(jié)局影響的臨床分析[D];東南大學(xué);2015年

3 侯麗;IVF-ET雙胎妊娠的風(fēng)險分析及分挽方式選擇[D];安徽醫(yī)科大學(xué);2015年

4 賈曼;IKAP模式在降低雙胎妊娠婦女剖宮產(chǎn)率中的應(yīng)用研究[D];重慶醫(yī)科大學(xué);2016年

5 劉云;雙胎妊娠258例臨床分析[D];大連醫(yī)科大學(xué);2016年

6 徐迎雪;絨毛膜性對雙胎妊娠結(jié)局的影響[D];吉林大學(xué);2017年

7 張曼;雙胎妊娠272例臨床分析[D];山東大學(xué);2012年

8 石巧玲;雙胎妊娠母兒并發(fā)癥的分析[D];福建醫(yī)科大學(xué);2013年

9 盧小紅;超聲對雙胎妊娠孕婦心功能的縱向研究[D];中南大學(xué);2013年

10 劉怡然;圍孕期補充葉酸與雙胎妊娠發(fā)生及其圍產(chǎn)結(jié)局相關(guān)性的Meta分析[D];重慶醫(yī)科大學(xué);2013年

，

本文編號：2407903