发育不同一性双胎妊娠的妊娠结局临床分析

目的探讨发育不同一性双胎妊娠的临床诊断、处理与妊娠结局。方法以双胎胎儿体重差〉20%为发育不同一性双胎妊娠诊断标准,回顾性分析比较1997年1月-2009年8月间中山三院分娩的66例发育不同一性双胎妊娠（观察组）与同期312例发育一致双胎妊娠（对照组）的临床资料,比较两组在妊娠并发症、合并症、分娩情况和围产儿预后等的差异。结果观察组晚期流产、早产、羊水过多、双胎输血综合征、双胎之一胎死宫内和胎盘早剥的发生率分别为18.2%（12/66）、63.6%（42/66）、30.0%（20/66）、34.8%（23/66）、13.6%（9/66）和4.5%（3/66）,对照组为8.0%（25/312）、35.9%（112/312）、14.7%（46/312）、1.3%（4/312）、3.8%（12/312）、0.96%（3/312）,两组间比较差异有统计学意义（P〈0.01）;观察组剖宫产率78.8%（52/66）,阴道分娩率21.2%（14/66）,对照组剖宫产率为75.0%（234/312）,阴道分娩率25.0%（78/312）,两组间差异无统计学意义（P〉0.01）;观察组围产儿病死率18.1%（24/132）,新生儿窒息率44.7%（59/132）,对照组围产儿病死率为2.9%（18/624）,新生儿窒息率15.7%（98/624）,两组间比较差异有统计学意义（P〈0.01）;观察组胎儿畸形的发生率为3.7%（5/132）,显著高于对照组0.6%（4/624）。结论发育不同一性双胎妊娠主要的并发症（晚期流产、早产、羊水过多、双胎输血综合征、胎盘早剥、围产儿死亡、新生儿窒息和胎儿畸形）发生率明显高于发育一致双胎妊娠,临床上应给予重视,及时发现,及时诊断,适时终止妊娠以提高围产质量。

Perinatal Outcome of Discordant Twin Pregnancies

Objective To discuss peripartum obstetrics events and perinatal outcomes of discordant twin pregnancies.Methods Discordant growth was defined as the intra-pair difference in birth weight more than 20%.Sixty-six discordant twin pregnancies（observed group） and 312 concordant ones（control group） during the period of January 1997 to October 2009 who delivered in our hospital were compared in pregnant complications and perinatal outcomes.Results Incidence of late abortion（18.2% vs 8.0%）,preterm labor（63.6% vs 35.9%）,polyhydramnios（30.0% vs 14.7%）,twin-twin transfusion syndrome（34.8% vs 1.3%）,death of one fetus （13.6% vs 3.8%）,placental abruption（4.50% vs 0.96%）,perinatal death（18.1% vs 4.9%）,neonatal asphyxia（44.7% vs 15.7%） and fetal malformation（3.7% vs 0.6%） in observed group were much higher than in control group,the differences were significant.Conclusion Discordance twins had a increased risk for late abortion,premature delivery,polyhydramnios,twin-twin transfusion syndrome,placental abruption,perinatal death and fetal malformation.More attention should be paid clinically to discover and diagnosis,termination in time was very important for improving the perinatal outcomes.