围生期结局在伴有母体发病率的双胎妊娠中的表现：来自世卫组织产妇和新生儿健康多国调查的证据。
Perinatal outcomes in twin pregnancies complicated by maternal morbidity: evidence from the WHO Multicountry Survey on Maternal and Newborn Health.
机构信息
Department of Obstetrics and Gynecology, University of Campinas, Alexander Fleming Street, 101, Campinas, SP, 13083-891, Brazil.
UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
出版信息
BMC Pregnancy Childbirth. 2018 Nov 20;18(1):449. doi: 10.1186/s12884-018-2082-9.
BACKGROUND
Twin pregnancy was associated with significantly higher rates of adverse neonatal and perinatal outcomes, especially for the second twin. In addition, the maternal complications (potentially life-threatening conditions-PLTC, maternal near miss-MNM, and maternal mortality-MM) are directly related to twin pregnancy and independently associated with adverse perinatal outcome. The objective of the preset study is to evaluate perinatal outcomes associated with twin pregnancies, stratified by severe maternal morbidity and order of birth.
METHODS
Secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS), a cross-sectional study implemented in 29 countries. Data from 8568 twin deliveries were compared with 308,127 singleton deliveries. The occurrence of adverse perinatal outcomes and maternal complications were assessed. Factors independently associated with adverse perinatal outcomes were reported with adjusted PR (Prevalence Ratio) and 95%CI.
RESULTS
The occurrence of severe maternal morbidity and maternal death was significantly higher among twin compared to singleton pregnancies in all regions. Twin deliveries were associated with higher rates of preterm delivery (37.1%), Apgar scores less than 7 at 5th minute (7.8 and 10.1% respectively for first and second twins), low birth weight (53.2% for the first and 61.1% for the second twin), stillbirth (3.6% for the first and 5.7% for the second twin), early neonatal death (3.5% for the first and 5.2% for the second twin), admission to NICU (23.6% for the first and 29.3% for the second twin) and any adverse perinatal outcomes (67% for the first twin and 72.3% for the second). Outcomes were consistently worse for the second twin across all outcomes. Poisson multiple regression analysis identified several factors independently associated with an adverse perinatal outcome, including both maternal complications and twin pregnancy.
CONCLUSION
Twin pregnancy is significantly associated with severe maternal morbidity and with worse perinatal outcomes, especially for the second twin.
背景
双胞胎妊娠与新生儿和围产儿不良结局的发生率显著增加相关，特别是对于第二胎。此外，母体并发症（潜在危及生命的情况-PLTC、母体接近错失-MNM 和孕产妇死亡-MM）与双胎妊娠直接相关，并与不良围产儿结局独立相关。本研究的目的是评估与双胎妊娠相关的围产儿结局，并按严重母体发病率和分娩顺序进行分层。
方法
对世界卫生组织多国家母婴健康调查（WHOMCS）的二次分析，这是一项在 29 个国家实施的横断面研究。将 8568 例双胎分娩的数据与 308127 例单胎分娩的数据进行比较。评估不良围产儿结局和母体并发症的发生情况。报告与不良围产儿结局独立相关的因素，采用调整后的 PR（患病率比）和 95%CI。
结果
在所有地区，与单胎妊娠相比，双胎妊娠的严重母体发病率和孕产妇死亡率显著更高。双胎分娩与早产率较高相关（37.1%），第 5 分钟 Apgar 评分低于 7 分（第一胎和第二胎分别为 7.8%和 10.1%），低出生体重（第一胎为 53.2%，第二胎为 61.1%），死胎（第一胎为 3.6%，第二胎为 5.7%），早期新生儿死亡（第一胎为 3.5%，第二胎为 5.2%），入住新生儿重症监护病房（NICU）（第一胎为 23.6%，第二胎为 29.3%）和任何不良围产儿结局（第一胎为 67%，第二胎为 72.3%）。在所有结局中，第二胎的结局都明显更差。泊松多项回归分析确定了几个与不良围产儿结局独立相关的因素，包括母体并发症和双胎妊娠。
结论
双胎妊娠与严重母体发病率和围产儿不良结局显著相关，特别是对于第二胎。
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