10年32例三胎妊娠的临床分析

目的 分析三胎妊娠的临床特点和影响妊娠结局的因素,为多胎妊娠的围产期保健和并发症防治提供参考,以改善多胎妊娠的妊娠结局.方法 1997年1月1日至2006年12月31日10年间我院28周后共分娩了三胎妊娠共32例(分娩孕周均<37周),选择与每例三胎妊娠在相同月份分娩的同孕周的2～3例双胎妊娠(共68例)及单胎妊娠(共89例)作为对照,比较母儿并发症等情况.结果 10年中三胎妊娠发生率前5年为0.05%,后5年为0.07%(P<0.05).三胎妊娠组孕产妇的各种并发症发病率(如妊娠期高血压疾病、低蛋白血症、贫血)均显著高于双胎及单胎组(P>0.05).三胎妊娠组新生儿各种并发症(如湿肺、肺炎及新生儿窒息等)与双胎及单胎组差异无统计学意义(P>0.05).三胎、双胎及单胎妊娠组的围产儿死亡率分别是135.4‰、60.2‰及56.2‰(P>0.05).三胎、双胎妊娠组剖宫产率分别为90.6%及91.2%,明显高于单胎组的48.3%(P<0.01).三胎妊娠组阴道分娩与剖宫产分娩两组的新生儿死亡率(70.6‰和3/7)、呼吸窘迫综合征发生率(4.7%和3/7)和颅内出血发生率(11.8%和3/7)比较差异有统计学意义(P<0.01或<0.05).结论 多胎妊娠较单胎及双胎妊娠孕妇易发生并发症;早产可能是造成三胎妊娠不良妊娠结局的主要因素;剖宫产可作为三胎妊娠的首选分娩方式.

Analysis of 32 triplets pregnancies during 10 years

Objective To study the clinical features of triplet pregnancies and the factors influencing the pregnancy outcomes in order to improve the perinatal care and prevent the complications. Methods We retrospectively analyzed the maternal and neonatal complications of 198 pregnancies (32 triplets, 68 twins and 89 singleton pregnancies, with matched gestational age at delivery) that delivered after 28 weeks in our hospital from Jan. 1997 to Dec. 2006. All 32 triplets delivered between 28-37 weeks. Results The incidence of triplet pregnancies in the former 5 years (0. 05%) were similar to the later 5 years (0. 07%), P>0. 05. The rates of hypertensive disorders complicating pregnancy, hypoproteinemia and anemia in the triplets were significantly higher than in the twins and singletons (P< 0.05 ). The common neonatal complications of the triplets were hypoglycemia, wet lung and intracranial hemorrhage. The prevalence of neonatal complications showed no difference among the three groups. The perinatal mortality of the triplets were 135. 4‰,60. 2‰ in the twins, and 56. 2‰ in the singletons (P>0. 05). The cesarean section rate of the triplets and the twins were 90. 6% and 91.2% ,which were significantly higher than that of the singletons (48. 3% ), P<0. 01. The neonatal mortality rate and the incidence of neonatal respiratory distress syndrome and intracranial hemorrhage were significantly higher in the vaginal delivered babies than those of the cesarean section delivered ones in triplets (70. 6% vs 3/7, 4. 7% vs 3/7, 11.8% vs 3/7, P<0. 01 or 0. 05). Condusions Triplets pregnancies will have more maternal complications than twins and singletons without reduction of the neonatal complications and perinatal mortality rate. Preterm birth may be the main reason for the adverse outcomes in the triplets. Cesarean section can be the first choice for triplets delivery.