Walker Allison R, Waites Bethany T, Caughey Aaron B
Department of Obstetrics and Gynecology, Oregon Health & Sciences University, Portland, OR, USA.
J Matern Fetal Neonatal Med. 2020 Mar;33(6):895-900. doi: 10.1080/14767058.2018.1508438. Epub 2018 Sep 19.
Compared to singleton pregnancies, small for gestational age (SGA) and twin gestations experience adverse maternal and neonatal outcomes. Specific data regarding outcomes in late preterm SGA twin gestations are lacking. This study sought to compare pregnancy outcomes of late preterm (≥34 and <37 weeks) SGA twins versus singletons. In addition, we sought to stratify the comparisons by <10 and <5 percentile categories. In this retrospective cohort of 1.85 million pregnancies, we identified 10,646 nonanomalous, SGA, late preterm singleton and twin pregnancies. Births at gestational ages <34 and ≥37 weeks were excluded. Multivariate regression analyses and Chi-squared test were used for statistical comparisons and a -value of less than 0.05 was used to indicate statistical significance. After controlling for race, education, parity, prenatal care, diabetes, and hypertensive disease, twin pregnancies were less likely to experience neonatal death (aOR 0.14; 95% CI 0.03-0.63; = .01) and intrauterine fetal demise (IUFD) (aOR 0.16; 95% CI 0.08-0.31; < .001) compared to SGA <10 percentile singletons. Cesarean rates were higher in SGA <10 [percentile twin pregnancies (aOR 3.40; 95% CI 3.01-3.90; < .001) as were postpartum hemorrhage (aOR 2.01; 95% CI 1.52-2.67; < .001) and transfusion (aOR 1.54; 95% CI 1.52-2.67; = .024). Late preterm SGA twin pregnancies were more like to be complicated by cesarean delivery, postpartum hemorrhage, and maternal transfusion compared to singleton pregnancies. However, neonatal death and IUFD were less common in SGA twin gestations.
与单胎妊娠相比，小于胎龄儿（SGA）和双胎妊娠会出现不良的母婴结局。目前缺乏关于晚期早产SGA双胎妊娠结局的具体数据。本研究旨在比较晚期早产（≥34周且<37周）SGA双胎与单胎的妊娠结局。此外，我们试图按百分位数<10和<5进行分层比较。在这个包含185万例妊娠的回顾性队列研究中，我们确定了10646例非畸形、SGA、晚期早产的单胎和双胎妊娠。排除孕周<34周和≥37周的分娩。采用多因素回归分析和卡方检验进行统计学比较，P值小于0.05表示具有统计学意义。在控制了种族、教育程度、产次、产前护理、糖尿病和高血压疾病后，与百分位数<10的SGA单胎妊娠相比，双胎妊娠发生新生儿死亡（调整后比值比[aOR]0.14；95%置信区间[CI]0.03 - 0.63；P = 0.01）和胎儿宫内死亡（IUFD）（aOR 0.16；95% CI 0.08 - 0.31；P < 0.001）的可能性较小。百分位数<10的SGA双胎妊娠的剖宫产率较高（aOR 3.40；95% CI 3.01 - 3.90；P < 0.001），产后出血（aOR 2.01；95% CI 1.52 - 2.67；P < 0.001）和输血（aOR 1.54；95% CI 1.52 - 2.67；P = 0.024）的发生率也较高。与单胎妊娠相比，晚期早产SGA双胎妊娠更易并发剖宫产、产后出血和产妇输血。然而，SGA双胎妊娠中新生儿死亡和IUFD较少见。
