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目的探讨双胎妊娠分娩时机与新生儿窒息之间的关系。方法对国内10家医院2013年分娩的2819例双胎妊娠临床资料进行回顾性分析,统计双胎各孕周分娩比例;比较各孕周新生儿出生体重、新生儿窒息率。结果 2819例双胎妊娠晚期流产率为7.31%(206/2819),主要集中在妊娠26~27+6周;早产率为64.31%(1813/2819);28周后活产新生儿平均体重:大胎儿为(2438.4±527.5)g,小胎儿为(2155.9±517.1)g,妊娠39周后活产儿出生体重增长趋势下降;活产新生儿窒息率:大胎儿为5.38%(138/2565),小胎儿为6.28%(152/2427),妊娠29~29~(+6)周与30~30~(+6)组周、34~34~(+6)周与35~35~(+6)周组差异有统计学意义(P<0.05)。结论双胎流产发生孕周主要集中在26~27~(+6)周。随妊娠周数增加,新生儿窒息率逐渐下降;妊娠30周前新生儿窒息比例高,妊娠35周后新生儿窒息率显著下降。对无明显并发症的双胎妊娠应尽可能延长孕周至36~38~(+6)周,但不宜超过39周。
Objective To investigate the relationship between the timing of twin pregnancy and neonatal asphyxia. Methods The clinical data of 2,819 twin pregnancies delivered in 10 hospitals in China in 2013 were retrospectively analyzed. The proportion of births in each gestation week was calculated. The birth weight and neonatal asphyxia rate in each gestational week were compared. Results The rate of abortion in the second trimester of pregnancy was 7.31% (206/2819), mainly in the period from 26 to 27 + 6 weeks. The rate of premature delivery was 64.31% (1813/2819). The average live weight of newborns after 28 weeks: (2438.4 ± 527.5) g for small fetus and (2155.9 ± 517.1) g for small fetus. The weight gain of live births decreased after 39 weeks gestation. The asphyxial rate of live births was 5.38% (138/2565) Small fetuses were 6.28% (152/2427), 29-29 (+6) weeks and 30-30 (+6) weeks, 34-34 (+6) weeks and 35-35 (+6) ) Week group differences were statistically significant (P <0.05). Conclusions The gestational age of twin abortion is mainly concentrated in 26 ~ 27 ~ (+6) weeks. As the number of gestational weeks increases, the asphyxia rate of neonates gradually declines; the proportion of newborns asphyxiated before pregnancy is high, and the asphyxia rate of newborns decreases significantly after 35 weeks of gestation. Twin pregnancies without obvious complication should be prolonged as long as 36 ~ 38 ~ (+6) gestational weeks, but not more than 39 weeks.