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目的探讨双胎妊娠绒毛膜性对孕期及围生儿预后的影响,进而明确双胎的绒毛膜性诊断、产前管理及双胎特有并发症的处理规范。方法回顾性分析我院2011-2014年的双胎病例435例,根据绒毛膜性分为单绒毛膜双羊膜囊双胎(monochrionic diamniotic twin,MCDA)和双绒毛膜双羊膜囊双胎(dichorionic diamniotic twin,DCDA)2组,对其孕期并发症、畸形发病率、分娩孕周和新生儿体重及预后等进行分析。结果 MCDA组的自然受孕率和胎儿畸形率(84.38%、7.03%)明显高于DCDA组(38.76%、3.91%,P均<0.05),差异有统计学意义。MCDA组分娩孕周明显小于DCDA组(33.17±5.25 vs.35.39±3.32,P<0.001),其急诊剖宫产率明显高于DCDA组[36.19%(38/105)vs.19.86%(56/282),P<0.05],差异均有统计学意义。MCDA组新生儿出生体重明显小于DCDA组,新生儿的轻度、重度窒息率,流产率,胎死宫内发生率均高于DCDA组。生后死亡及死产率发生例数较少,暂无可比性。MCDA组特殊并发症的发生率明显高于DCDA组。结论双胎妊娠的绒毛膜性判断对于双胎的产前管理及预后可起到关键作用,双胎特殊并发症由于发病机制的不完全明确,其管理及治疗还需要不断总结并个性化指导及治疗。
Objective To investigate the effect of chorionicity in twin pregnancy on the prognosis of pregnant women and perinatal infants, so as to clarify the treatment of chorionicity, prenatal management and special complications of twins. Methods A retrospective analysis of 435 cases of twin fetuses in our hospital from 2011 to 2014 was conducted and divided into two groups: monochrionic diamniotic twin (MCDA) and dichorionic diamniotic twin, DCDA) were divided into two groups and analyzed their complications of pregnancy, the incidence of deformity, gestational age of childbirth and body weight and prognosis of neonates. Results The rate of spontaneous conception and fetal malformation (84.38%, 7.03%) in MCDA group was significantly higher than that in DCDA group (38.76%, 3.91%, P <0.05). The difference was statistically significant. The gestational weeks of delivery in MCDA group were significantly shorter than those in DCDA group (33.17 ± 5.25 vs.35.39 ± 3.32, P <0.001). The rate of cesarean section in MCDA group was significantly higher than that in DCDA group [36.19% (38/105) vs.19.86% (56 / 282), P <0.05], the differences were statistically significant. The birth weight of neonates in MCDA group was significantly less than that in DCDA group. The neonatal mild to severe asphyxia, abortion rate and intrauterine fetal death rate were higher than DCDA group. After birth, the number of deaths and stillbirths is relatively small. The incidence of special complication in MCDA group was significantly higher than that in DCDA group. Conclusion The judgment of chorionicity in twin pregnancy may play a key role in the prenatal management and prognosis of twins. Because of the incomplete pathogenesis of twin complications, the management and treatment of twins need to be summarized and personalized. treatment.