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目的:调查阴道产及子宫下段剖宫产两种分娩方式对双胎妊娠结局的影响及妊娠相关危险因素。方法:回顾性分析2011年1月~2012年12月于该院产科分娩的双胎妊娠共108例的病历资料,其中,阴道产为40例,子宫下段剖宫产为68例,统计双胎妊娠孕妇的并发症发生率,并对行阴道产、子宫下段剖宫产两种分娩方式产妇的产后出血、孕周、新生儿窒息率及死亡率等指标进行比较。结果:双胎妊娠发生率最高的并发症为早产,其次为子痫前期-子痫。孕37周~、孕34周~孕妇新生儿的窒息率及死亡率均明显低于孕31周~,差异有统计学意义(P<0.05)。在娩出第1胎新生儿时,阴道产与子宫下段剖宫产两种分娩方式新生儿窒息率差异无统计学意义(P>0.05)。在娩出第2胎新生儿时,阴道产新生儿窒息率较第1胎明显升高,较子宫下段剖宫产新生儿亦明显升高,差异均有统计学意义(均P<0.05)。阴道产与子宫下段剖宫产两种分娩方式产后出血发生率差异无统计学意义(P>0.05);阴道产<37周孕妇占37.50%,而子宫下段剖宫产为44.12%,两种分娩方式的孕妇孕周分布差异无统计学意义(P>0.05);子宫下段剖宫产新生儿体重≥2.5 kg明显高于阴道产,两者间差异有统计学意义(P<0.05)。结论:子宫下段剖宫产可降低新生儿的窒息率,推荐广泛应用于临床。
Objective: To investigate the vaginal delivery and lower uterine segment of cesarean section of two delivery methods on the outcome of twin pregnancy and pregnancy-related risk factors. Methods: A retrospective analysis of January 2011 to December 2012 in the hospital obstetric delivery of twins of a total of 108 cases of medical records, of which 40 cases of vaginal delivery, uterine segment of the lower caesarean section was 68 cases of statistical twin The incidence of complications of pregnant women in pregnancy, and vaginal delivery, uterine cesarean section of the lower part of the two modes of delivery of maternal postpartum hemorrhage, gestational age, neonatal asphyxia and mortality and other indicators were compared. Results: The most common complication of twin pregnancy was premature labor, followed by preeclampsia and eclampsia. 37 weeks of gestation ~ 34 weeks of pregnancy ~ neonatal asphyxia and maternal mortality were significantly lower than that of 31 weeks of gestation, the difference was statistically significant (P <0.05). There was no significant difference in neonatal asphyxia between vaginal delivery and uterine cesarean delivery in the first fetus neonates (P> 0.05). When the second fetus was delivered, asphyxia rate of vaginally newborns was significantly higher than that of the first fetus, but also significantly higher than that of the newborns with lower uterine segment (all P <0.05). There was no significant difference in the incidence of postpartum hemorrhage between vaginal delivery and lower uterine cesarean delivery (P> 0.05); vaginal delivery was less than 37.50% for 37 weeks pregnant women and 44.12% for uterine cesarean section (P> 0.05). The weight of newborns in the lower uterine segment of cesarean section≥2.5 kg was significantly higher than that of the vagina (P <0.05). Conclusion: Cesarean section of the lower uterine segment can reduce neonatal asphyxia, which is widely used in clinic.