Department of Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, Guangdong Province, China.
Departments of Neurosurgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510630, Guangdong Province, China.
BMC Pregnancy Childbirth. 2021 Jan 11;21(1):46. doi: 10.1186/s12884-020-03528-0.
In recent years, first-trimester intrauterine hematoma (IUH) has become increasingly common in twin pregnancy. The majority of studies on IUH have excluded twin pregnancies, and others did not differentiate between singleton and twin pregnancies. The impact of IUH on twin pregnancy is unclear. Therefore, the primary objective of our study was to examine associations between first-trimester IUH and pregnancy outcomes in twin pregnancies.
The data of 1020 twin pregnancies in women who received a routine examination from January 2014 to December 2018 were reviewed. We compared baseline data and pregnancy outcomes between those with and without IUH. Multivariable logistic regression analysis was used to adjust for possible confounding factors.
A total of 209 patients (21.3%) developed IUH in the first trimester. First-trimester IUH was significantly associated with increased odds of miscarriage (adjusted odds ratio 14.27, 95% CI 8.25-24.70) and vanishing twin syndrome (adjusted odds ratio 3.26, 95% CI 1.11-4.61). However, there were no differences in the rates of stillbirth, preeclampsia, preterm labor (< 34 weeks), low birth weight, postpartum hemorrhage or fetal distress between the two groups. Maternal age, previous preterm birth, chorionicity in twins and the gestational week at first ultrasound did not differ between the two groups. The women with IUH had high rates of previous miscarriage (46.73% vs 38.37%, p = 0.01), assisted conception (48.56% vs 32.60%, p < 0.001) and accompanied vaginal bleeding (67.46% vs 13.43%, p < 0.001). According to the logistic regression analyses, these characteristics were not associated with pregnancy loss or vanishing twin syndrome. No IUH characteristics, including volume, largest diameter, or the presence of vaginal bleeding, were associated with pregnancy loss or vanishing twin syndrome before 20 weeks of gestation (P > 0.05).
In women with twin pregnancy, the presence of IUH in the first trimester was associated with the loss of one or both fetuses before 20 weeks of gestation. However, previous miscarriage, the conception method, the IUH size and the presence of vaginal bleeding were not independently associated with miscarriage or vanishing twin syndrome.
近年来，早孕期宫腔积血（IUH）在双胎妊娠中越来越常见。大多数关于 IUH 的研究都排除了双胎妊娠，而其他研究则没有区分单胎和双胎妊娠。IUH 对双胎妊娠的影响尚不清楚。因此，本研究的主要目的是探讨早孕期 IUH 与双胎妊娠结局的关系。
回顾性分析 2014 年 1 月至 2018 年 12 月期间在我院常规检查的 1020 例双胎妊娠患者的临床资料。比较 IUH 组与非 IUH 组的基本资料及妊娠结局。采用多变量 logistic 回归分析调整可能的混杂因素。
共 209 例（21.3%）患者在早孕期出现 IUH。早孕期 IUH 与流产（调整优势比 14.27，95%置信区间 8.25-24.70）和双胎消失综合征（调整优势比 3.26，95%置信区间 1.11-4.61）的发生风险增加显著相关。然而，两组间死胎、子痫前期、早产（<34 周）、低出生体重儿、产后出血或胎儿窘迫的发生率无差异。两组间的产妇年龄、既往早产史、双胎绒毛膜性及首次超声检查的孕周无差异。IUH 组既往流产史（46.73% vs 38.37%，p=0.01）、辅助受孕（48.56% vs 32.60%，p<0.001）及伴有阴道出血（67.46% vs 13.43%，p<0.001）的发生率较高。logistic 回归分析显示，这些特征与妊娠丢失或双胎消失综合征无关。在早孕期，IUH 的特征，包括体积、最大直径或阴道出血的存在，与妊娠丢失或双胎消失综合征无关（P>0.05）。
在双胎妊娠妇女中，早孕期 IUH 与 20 周前的单胎或双胎丢失有关。然而，既往流产史、受孕方式、IUH 大小及阴道出血与流产或双胎消失综合征无关。
