提倡规律产前检查降低多胎妊娠围产儿死亡率

目的:分析并总结多胎妊娠围产儿死亡高危因素。方法:收集1986年1月~2003年3月间的285例多胎妊娠(双胎妊娠275例,3胎妊娠10例)共580例围产儿,总结其围产期主要并发症及围产儿预后;并以1993年和2002年共计2 453例单胎妊娠的并发症作为对照,分析多胎妊娠围产儿死亡的相关因素。结果:①多胎妊娠并发症高,主要为早产、胎膜早破、妊高征及贫血,与单胎对照组比较均有显著性差异(P<0.01);②多胎妊娠围产儿死亡发生率是58.6‰(34/580),较同期的单胎妊娠围产儿死亡率明显升高。死胎与早期新生儿死亡各占50.0%。死胎中有致死性畸形4例,双胎输血综合征死亡3例,原因不明10例;新生儿死亡中有2例致死性畸形,其余15例均为早产儿,平均孕周为31.5周,新生儿死亡主要原因:早产儿肺出血、新生儿肺透明膜病(RDS)、感染、心衰;除外畸形,围产儿体重与围产儿死亡关系最为密切。③规律产前检查与无规律产前检查组比较,妊娠并发症的发生率无明显差异,但围产儿死亡率差异有显著性(P<0.05)。结论:多胎妊娠并发症较单胎妊娠并发症明显增加,早产是多胎妊娠围产儿死亡的主要影响因素,加强产前保健对延长孕周、增加胎儿体重、减少新生儿并发症,从而降低多胎围产儿死亡率有重要意义。

Advocate routine antenatal examination to reduce the mortality of multiple pregnant perinatal fetuses

To analyze and sum up the high risk factors of multiple pregnant perinatal fetuses' death. Methods: 285 cases of multiple pregnant perinatal fetuses from Jan. 1986 to Mar. 2003 were collected to summarize the main perinatal complications and prognosis. The complications of 2 453 cases of single pregnant fetuses from 1993 to 2002 were control group. The correlated factors of multiple pregnant perinatal fetuses' death were analyzed. Results: ①The common complications of multiple pregnancy were: Premature delivery, premature rupture of caul, pregnancy induced hypertension and anemia. Comparing the control group, there were significant difference (P<0. 01); ②The mortality of multiple pregnant perinatal fetuses was 58. 6‰(34/580) and higher than that of control group. The fetuses' death and neonate' death were 50.0% respectively. There were 4 cases with deadly abnormality, 3 cases with transfusion syndrome and 10 cases with uncertain causes in the dead perinatal fetuses. There were 2 cases with deadly abnormality, 15 cases with premature delivery and 31. 5 weeks of average pregnancy. The main causes for infants' death were: premature combined with pulmonary hemorrhage, neonatal respiratory distress syndrome (RDS),infection and heart failure. Except abnormality, perinatal fetuses' weight had close relationship with death of perinatal fetuses. There were not significant difference of complications. but significant difference of perinatal fetuses' mortality (P<0.05) between routine antenatal examination group and ruleless antenatal examination group. Conclusion: Multiple pregnant perinatal fetuses' complications was more than that of single pregnancy, premature delivery was the main influential factor of multiple pregnant perinatal fetuses. Strengthening antenatal healthcare had great significance in prolonging gestation, increasing fetuses' weight. decreasing neonatal complications to reduce the mortality.