单胎和多胎妊娠中与胎盘早剥相关的围产期死亡率。

Perinatal mortality associated with abruptio placenta in singletons and multiples.

作者信息

Salihu Hamisu M, Bekan Brigitte, Aliyu Muktar H, Rouse Dwight J, Kirby Russell S, Alexander Greg R

机构信息

Department of Maternal and Child Health, University of Alabama at Birmingham 35294, USA.

出版信息

Am J Obstet Gynecol. 2005 Jul;193(1):198-203. doi: 10.1016/j.ajog.2005.05.021.

DOI:10.1016/j.ajog.2005.05.021

PMID:16021079

Abstract

OBJECTIVE

This study was undertaken to investigate the association among plurality (number of fetuses per pregnancy), abruptio placenta, and perinatal mortality.

STUDY DESIGN

A retrospective cohort study on 15,051,872 singletons, 413,619 twins, and 22,585 triplets delivered in the United States between 1995 and 1998 was conducted. We compared the occurrence of perinatal death between pregnancies complicated by abruptio placenta and those without with the use of adjusted odds ratios. The generalized estimating equations framework was applied to adjust for intracluster correlations among multiples.

RESULTS

Placental abruption occurred among 93,968 singletons (6.2 per 1000), 5051 twin (12.2 per 1000), and 353 triplet (15.6 per 1000) gestations ( P for trend<.0001). Placental abruption was associated with significant risk of mortality irrespective of the plurality subtype. Perinatal mortality was greatest among singletons (adjusted odds ratio [95% CI]=14.3[13.2-15.4]), followed by twins (4.4[3.9-4.9]) and least among triplets (3.0[2.0-4.6]) ( P for trend<.0001).

CONCLUSION

As plurality increases from 1 to 3, the risk of placental abruption rises, whereas the risk of abruptio-associated perinatal mortality declines.

摘要

目的

本研究旨在调查多胎妊娠（每次妊娠的胎儿数量）、胎盘早剥与围产期死亡率之间的关联。

研究设计

对1995年至1998年在美国分娩的15051872名单胎、413619对双胞胎和22585名三胞胎进行了一项回顾性队列研究。我们使用调整后的优势比比较了并发胎盘早剥的妊娠和未并发胎盘早剥的妊娠之间围产期死亡的发生率。应用广义估计方程框架来调整多胎妊娠组内的相关性。

结果

93968名单胎妊娠（每1000例中有6.2例）、5051对双胞胎妊娠（每1000例中有12.2例）和353名三胞胎妊娠（每1000例中有15.6例）发生了胎盘早剥（趋势P值<.0001）。无论多胎妊娠的亚型如何，胎盘早剥都与显著的死亡风险相关。围产期死亡率在单胎妊娠中最高（调整后的优势比[95%可信区间]=14.3[13.2-15.4]）,其次是双胞胎妊娠（4.4[3.9-4.9]），在三胞胎妊娠中最低（3.0[2.0-4.6]）（趋势P值<.0001）。