双胎输血综合征与发育不同一性双胎妊娠的妊娠结局对比分析

目的分析比较双胎输血综合征与发育不同一性双胎妊娠的妊娠结局。方法收集1999年1月至2009年8月中山三院分娩的23例双胎输血综合征(A组)和43例发育不同一性双胎妊娠(B组)的临床资料,对比分析2组在一般情况、发生孕周、妊娠并发症、合并症、分娩情况和围产儿预后方面的差异。结果 A组平均发生孕周为25+4周,较B组平均发生孕周31+3周要早,A组分娩孕周平均为29+5周,B组分娩孕周平均为35+3周,2组差异有统计学意义(P<0.05)。A组晚期流产、羊水过多、双胎之一胎死宫内和胎盘早剥的发生率分别为26.1%、47.8%、21.7%和13%,B组为13.9%、20.9%、9.3%和2.3%,2组差异有统计学意义(P<0.05)。A组围产儿死亡率45.7%,新生儿窒息率69.6%;B组围产儿死亡率为30.2%,新生儿窒息率40.7%,2组差异有统计学意义(P<0.05)。A组新生儿平均出生体质量(1732±673)g,B组平均出生体质量为(2321±568)g,2组差异有统计学意义(P<0.05)。结论双胎输血综合征和发育不同一性双胎妊娠都是双胎妊娠特有的并发症,临床表现均以胎儿发育不一致为特征,然而2者在发病机制与妊娠结局上仍有不同,临床上应予重视并鉴别,及时处理,改善围产儿预后。

Perinatal outcome of discordant twin pregnancies

Objective To discuss peripartum obstetrics events and perinatal outcomes of twin to twin syndrome （TTTS） and discordant twin pregnancies. Methods Discordant growth was defined as the intra-pair difference in birth weight more than 20 % except TTTS. Totally 23 TTTS pregnancies （Group A） and 46 discordant twin ones （Group B） during the period of January 1997 and October 2009 who delivered in hospital were compared in pregnant complications and perinatal outcomes. Results The incidence of late abortion （26.1% vs 13.9 % ）, polyhydramnios （47.8 % vs 20.9 % ）, death of one fetus （21.7 % vs 9.3 % ）, placental abruption （13 % vs 2.3 % ）, perinatal death （45.7 % vs 30.2 % ）, and neonatal asphyxia （69.6 % vs 40.7 % ） were much higher in Group A than in Group B, and the differences were significant. The mean birth weight was significantly lower in Group A （1 732±673）g vs （2 321±568）g, P〈 0.05）. Conclusions TTTS and discordance twins are particular complications of twin pregnancies, they are similar in discordant development, but different in mechanism of onset and outcome of pregnancy. Clinically we should pay more attention to differentia and diagnosis in time for improving the perinatal outcomes.