三胎及双胎妊娠结局对照分析

　　【摘要】 目的 探讨三胎妊娠及双胎妊娠的临床特点及母婴妊娠结局。方法 回顾性分析于本院终止妊娠的201例双胎妊娠和78例三胎妊娠的临床资料， 将三胎妊娠作为研究组， 双胎妊娠作为对照组， 分析两组间年龄、孕产次、受孕方式及分娩方式、新生儿结局及妊娠期并发症。结果 ①研究组促排卵率、产次明显高于对照组， 差异有统计学意义（P<0.05）；孕次、体外受精-胚胎移值（IVF-ET）比较差异无统计学意义（P>0.05）。②研究组妊娠期肝内胆汁淤积综合征（ICP）和产后出血的发生率高于对照组， 差异有统计学意义（P<0.05）。妊娠期高血压疾病、胎膜早破的发生率差异无统计学意义（P>0.05）。③研究组新生儿平均出生体重明显低于对照组， 差异有统计学意义（P<0.05）。研究组新生儿窒息率、新生儿死亡率、胎儿丢失率、34周前早产率及37周前早产率均明显高于对照组， 差异有统计学意义（P<0.05）。④研究组平均终止妊娠孕周低于对照组， 差异有统计学意义（P<0.05）。两组间剖宫产率及胎儿畸形发生率差异无统计学意义（P>0.05）。结论 双胎妊娠及三胎妊娠各有临床特点， 三胎妊娠有更差的新生儿妊娠结局， 均需要进一步的研究。

　　【关键词】 双胎妊娠；三胎妊娠；妊娠结局；多胎妊娠

　　【Abstract】 Objective To investigate the clinical characteristics and pregnancy outcomes of gemellary pregnancy and triplet pregnancy. Methods The clinical data of 201 pregnancy termination cases of gemellary pregnancy and 78 cases of triplet pregnancy were retrospectively analyzed. The triplet pregnancy cases were taken as the research group and the gemellary pregnancy cases as the control group. The differences of age， gravidity and parity， fertilization ways， delivery ways， neonatal outcome， and pregnancy complications between the two groups were all analyzed. Results ① The parity and incidence of ovulation in research group were higher than those of the control group， and the differences had statistical significance （P<0.05）. There were no significant differences of gravidity and in vitro fertilization and embryo transfer （IVF-ET） between the two groups （P>0.05）. ② The incidences of intrahepatic cholestasis of pregnancy （ICP） and postpartum hemorrhage of the research group were higher than those of the control group， and the differences were statistically significant （P<0.05）. There were no significant differences of the incidences of hypertensive disorder complicating pregnancy and premature rupture of fetal membranes（P>0.05）. ③ The average birth weight of newborn in the research group was obviously lower than that in the control group， and the difference had statistical significance （P<0.05）. The incidences of neonatal asphyxia， newborn mortality， fetal loss， preterm birth rates before 34 weeks and 37 weeks of the research group were all higher than those of the control group， and the differences had statistical significance （P<0.05）. ④ The average pregnancy termination gestational weeks in the research group was shorter than that in the control group， and the difference was statistically significant （P<0.05）. There were no significant differences of the incidences of cesarean delivery and fetal malformation between the two groups （P>0.05）. Conclusion Gemellary pregnancy and triplet pregnancy have varied clinical characteristics， and triplet pregnancy is needed to be further researched due to its poor neonatal outcome.

　　【Key words】 Gemellary pregnancy； Triplet pregnancy； Pregnancy outcome； Multiple pregnancy

　　双胎妊娠和三胎妊娠均为多胎妊娠， 大多数文献均将其一并研究， 两者均有较差的新生儿妊娠结局。但三胎妊娠和双胎妊娠都有其临床特点， 并且三胎妊娠有更差的新生儿妊娠结局， 报告如下。

　　1 资料与方法

　　1. 1 一般资料 收集2011年9月～2013年10月于本院终止妊娠的双胎妊娠201例和2009年9月～2013年9月于本院终止妊娠的三胎妊娠78例的临床资料。分为研究组和对照组， 三胎妊娠78例为研究组， 双胎妊娠201例为对照组。研究组：年龄25～35岁， 孕次1～5次， 产次0～3次， 流产例数+引产例数7例， 34周之前分娩33例， 37周之前分娩67例， 足月分娩4例。初产妇46例， 经产妇32例， 明确促排卵史12例， 试管婴儿16例， 得婴128枚。对照组：年龄19～41岁， 孕次1～7次， 产次1～4次， 流产例数+引产例数27例， 34周之前分娩44例， 37周之前分娩111例， 足月分娩63例。初产妇120例， 经产妇81例， 促排卵0例， 试管婴儿38例， 得婴343枚。