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[不同孕周双胎妊娠适宜胎儿体重及妊娠并发症与结局的探讨]

[Exploration on appropriate fetal weight of twin pregnancies at different gestational weeks and pregnancy complications and outcomes].

作者信息

Zhang Q D, Wei Y M, Yang H X

机构信息

Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus, Beijing 100034, China.

出版信息

Zhonghua Fu Chan Ke Za Zhi. 2022 Nov 25;57(11):850-855. doi: 10.3760/cma.j.cn112141-20220512-00319.

Abstract

To explore the appropriate fetal weight of twin pregnancies at different gestational weeks and the association with pregnancy complications and outcomes. Fetal weight at different gestational weeks and related pregnancy complications and outcomes from 1 225 twin pregnancies, who gave birth at Peking University First Hospital from January 2004 to December 2020, were analyzed in this study, including hypertensive disorders in pregnancy, gestational diabetes mellitus (GDM), fetal growth restriction (FGR), fetal distress, preterm birth and neonatal asphyxia. The appropriate fetal weight of twin pregnancies at different gestational weeks were analysed based on the information from 616 twin pregnancies without complications (except preterm birth), and were expressed as ~. The chi-square test was used to compare the risk of pregnancy complications and adverse outcomes in large for gestational age (LGA), appropriate for gestational age (AGA) and small for gestational age (SGA) twin pregnancies and the difference in incidence of pregnancy complications and adverse outcomes in different years. The appropriate fetal weights of normal twin pregnancies at 28 to 37 weeks and 38-40 weeks of gestation were 910-1 255 g, 996-1 518 g, 1 105-1 785 g, 1 295-1 825 g, 1 336-2 000 g, 1 754-2 321 g, 1 842-2 591 g, 1 913-2 615 g, 2 150-2 847 g, 2 350-3 130 g and 2 450-3 250 g, respectively. The incidences of hypertensive disorders in pregnancy, FGR, fetal distress and neonatal asphyxia related to SGA twin pregnancies were significantly higher than AGA twin pregnancies (all <0.05). The incidence of GDM in twin pregnant from 2017 to 2020 was higher than that from 2004 to 2009 or from 2010 to 2016, but the incidence of fetal distress and neonatal asphyxia were lower than those from 2010 to 2016, and the differences were statistically significant (all <0.05). The appropriate weights of twin fetuses at different gestational weeks are different from singleton. The incidence of pregnancy complications and adverse outcomes in AGA fetuses is significantly lower than that in SGA fetuses under the specific weight standard for twin fetuses, which could provide a practical basis for clinical management of twin pregnancy.

摘要

探讨不同孕周双胎妊娠的适宜胎儿体重及其与妊娠并发症和结局的关系。本研究分析了2004年1月至2020年12月在北京大学第一医院分娩的1225例双胎妊娠不同孕周的胎儿体重及相关妊娠并发症和结局,包括妊娠期高血压疾病、妊娠期糖尿病(GDM)、胎儿生长受限(FGR)、胎儿窘迫、早产和新生儿窒息。基于616例无并发症(早产除外)双胎妊娠的信息分析不同孕周双胎妊娠的适宜胎儿体重,并表示为~。采用卡方检验比较大于胎龄(LGA)、适于胎龄(AGA)和小于胎龄(SGA)双胎妊娠的妊娠并发症和不良结局风险,以及不同年份妊娠并发症和不良结局发生率的差异。妊娠28至37周和38 - 40周正常双胎妊娠的适宜胎儿体重分别为910 - 1255g、996 - 1518g、1105 - 1785g、1295 - 1825g、1336 - 2000g、1754 - 2321g、1842 - 2591g、1913 - 2615g、2150 - 2847g、2350 - 3130g和2450 - 3250g。SGA双胎妊娠相关的妊娠期高血压疾病、FGR、胎儿窘迫和新生儿窒息的发生率显著高于AGA双胎妊娠(均<0.05)。2017至2020年双胎妊娠GDM的发生率高于2004至2009年或2010至2016年,但胎儿窘迫和新生儿窒息的发生率低于2010至2016年,差异有统计学意义(均<0.05)。不同孕周双胎胎儿的适宜体重与单胎不同。在双胎胎儿特定体重标准下,AGA胎儿妊娠并发症和不良结局的发生率显著低于SGA胎儿,可为双胎妊娠的临床管理提供实践依据。

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