Santana Danielly S, Cecatti José G, Surita Fernanda G, Silveira Carla, Costa Maria L, Souza João P, Mazhar Syeda B, Jayaratne Kapila, Qureshi Zahida, Sousa Maria H, Vogel Joshua P
Department of Obstetrics and Gynecology, University of Campinas, Campinas, and the Department of Social Medicine, Ribeirao Preto Medical School, University of São Paulo, São Paulo, Brazil; Pakistan Institute of Medical Sciences, Islamabad, Pakistan; the Maternal & Child Morbidity & Mortality Surveillance Unit, Family Health Bureau, Ministry of Health, Colombo, Sri Lanka; the Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya; and the Department of Reproductive Health Research from the World Health Organization, Geneva, Switzerland.
Obstet Gynecol. 2016 Apr;127(4):631-641. doi: 10.1097/AOG.0000000000001338.
To evaluate maternal complications (potentially life-threatening conditions, maternal near miss, and maternal death) that are mutually exclusive and severe maternal outcomes (maternal near miss or maternal death) associated with twin pregnancies.
We performed a secondary analysis of a cross-sectional World Health Organization Multicountry Survey, which was implemented in 29 countries. Data from 4,756 twin deliveries were compared with 308,111 singleton deliveries. Factors associated with maternal morbidity and twin pregnancies were reported with adjusted prevalence ratio (95% confidence interval).
Potentially life-threatening conditions, maternal near miss, severe maternal outcomes, and maternal deaths were 2.14 (1.99-2.30), 3.03 (2.39-3.85), 3.19 (2.58-3.94), and 3.97 (2.47-6.38) times higher, respectively, among twin pregnancies. Maternal age older than 20 years, having a partner, multiparity, and elective cesarean delivery were associated with twin pregnancies. Postpartum hemorrhage and chronic hypertension were more frequently associated with severe maternal outcomes among twin pregnancies. Conditions indicating organ dysfunction (maternal near miss) were twofold to fivefold higher for twins. Poisson multiple regression analysis identified several factors independently associated with a severe maternal outcome, but not twin pregnancies.
Twin pregnancy is associated with greater severe maternal morbidity and a higher rate of maternal death than singleton pregnancy.
评估双胎妊娠相关的相互排斥的孕产妇并发症（潜在危及生命的情况、孕产妇接近死亡和孕产妇死亡）以及严重孕产妇结局（孕产妇接近死亡或孕产妇死亡）。
我们对世界卫生组织在29个国家开展的一项横断面多国调查进行了二次分析。将4756例双胎分娩的数据与308111例单胎分娩的数据进行了比较。报告了与孕产妇发病率和双胎妊娠相关的因素，并给出调整后的患病率比（95%置信区间）。
双胎妊娠中，潜在危及生命的情况、孕产妇接近死亡、严重孕产妇结局和孕产妇死亡的发生率分别高出2.14（1.99 - 2.30）倍、3.03（2.39 - 3.85）倍、3.19（2.58 - 3.94）倍和3.97（2.47 - 6.38）倍。年龄大于20岁、有伴侣、经产和择期剖宫产与双胎妊娠相关。产后出血和慢性高血压在双胎妊娠中更常与严重孕产妇结局相关。提示器官功能障碍（孕产妇接近死亡）的情况在双胎中高出两倍至五倍。泊松多元回归分析确定了几个与严重孕产妇结局独立相关但与双胎妊娠无关的因素。
与单胎妊娠相比，双胎妊娠与更严重的孕产妇发病率和更高的孕产妇死亡率相关。
