选择性胎儿生长受限对妊娠结局的影响:一项回顾性队列研究

The impact of selective intrauterine growth restriction (sIUGR) on pregnancy outcomes: a retrospective cohort study

摘要

目的 回顾性分析单绒毛膜双羊膜囊(MCDA)双胎相关数据,探究选择性胎儿生长受限(sIUGR)对妊娠结局的影响。方法 回顾性研究2019年5月到2024年5月在西北妇女儿童医院产科分娩MCDA中保守治疗的108例sIUGR作为病例组,76例未合并并发症的MCDA作为对照组,对比分析两组孕妇及胎儿的基本信息和临床资料;根据生长受限儿舒张期血流情况,将病例组分为3型:Ⅰ型64例,Ⅱ型24例,Ⅲ型20例,对比三型间上述指标是否存在统计学差异,其中大胎儿为体质量大胎儿,小胎儿为体质量小胎儿。结果 与对照组相比,病例组分娩孕周显著减小,双胎儿体质量差值百分比显著增大,大、小胎儿出生体质量显著降低(t=-3.530、12.274、-6.151、-7.953,P<0.05),两组脐带插入点在大胎儿中均无插入点异常,病例组小胎儿脐带插入点异常发生率高(χ²=28.732,P<0.05),大、小胎儿Apgar评分均低(大胎儿:t=-4.161、-4.584、-3.660,小胎儿t=-3.170、-3.221、-4.291,P<0.05),新生儿科住院天数明显延长(t=2.043、3.841,P<0.05),大、小胎儿肺表面活性物质使用率、气管插管率、呼吸窘迫综合征发生率均较对照组高(χ²=9.070、8.279;29.119、20.087;26.490、18.255,P<0.05).sIUGR Ⅰ型、Ⅱ型、Ⅲ型间比较,上述指标均有统计学差异(P<0.05),同时发现与Ⅰ型、Ⅱ型大胎儿相比,Ⅲ型大胎儿住院时间最长、新生儿呼吸窘迫综合征(NRDS)发生率、坏死性小肠结肠炎(NEC)发生率、脑损伤发生率最高(F=3.952、14.822、18.198、27.006,P<0.05);与Ⅰ型和Ⅲ型小胎儿相比,Ⅱ型小胎儿住院时间最长,NRDS发生率、NEC发生率、脑损伤发生率最高(F=29.911、24.842、33.290、9.974,P<0.05)。结论 病例组胎儿出生后预后较对照组差.Ⅱ型小胎儿和Ⅲ型大胎儿易出现严重并发症,出生后应严密监测,积极预防.

Abstract

Objective To retrospectively analyze data from monochorionic diamniotic (MCDA) twin pregnancies and investigate the impact of selective intrauterine growth restriction (sIUGR) on pregnancy outcomes. Methods A case-control study was conducted on MCDA twins delivered in the Department of Obstetrics at Northwest Women's and Children's Hospital between May 2019 and May 2024. The case group comprised 108 sIUGR pregnancies managed conservatively, while the control group consisted of 76 uncomplicated MCDA pregnancies. Basic demographic information and clinical data from both mothers and fetuses were compared between the two groups. According to the end-diastolic flow pattern of growth-restricted fetuses, the sIUGR cases were stratified into three types: Type Ⅰ (n=64), Type Ⅱ (n=24), and Type Ⅲ (n=20). Differences in the above indicators among the three types were analyzed for statistical significance. Among them, large fetuses were large-weight fetuses and small fetuses were small-weight fetuses. Results Compared with the control group, the case group exhibited significantly earlier gestational age at delivery and a larger inter-twin birth weight discordance percentage. Both the larger and the smaller fetuses in the case group had significantly lower birth weights (t=-3.530, 12.274, -6.151 and -7.953, respectively, P<0.05). Regarding cord insertion sites, no abnormalities were found in the larger fetuses in either group. However, the smaller fetuses in the case group had a significantly higher incidence of abnormal cord insertion (χ²=28.732, P<0.05). The Apgar scores of both larger and smaller fetuses were significantly lower in the case group (larger fetuses: t=-4.161, -4.584 and -3.660, respectively; smaller fetuses: t=-3.170, -3.221 and -4.291, respectively; P<0.05). The duration of neonatal hospital stay was also significantly longer for both the larger and smaller neonates in the case group (t=2.043 and 3.841, respectively, P<0.05). Furthermore, the utilization rate of pulmonary surfactant, the rate of endotracheal intubation, and the incidence of respiratory distress syndrome were all significantly higher in both the larger and smaller fetuses of the case group compared to the control group (χ²=9.070, 8.279, 29.119, 20.087, 26.490 and 18.255, respectively, P<0.05). Significant differences were observed among sIUGR types Ⅰ, Ⅱ, and Ⅲ for all the above indicators (P<0.05). Among the larger fetuses, those in type Ⅲ had the longest hospitalization durations and the highest incidences of neonatal respiratory distress syndrome (NRDS), necrotizing enterocolitis (NEC), and brain injury compared with type Ⅰ and type Ⅱ (F=3.952, 14.822, 18.198 and 27.006, respectively, P<0.05). Conclusion The postnatal prognosis of fetuses in the case group was poorer than that of the control group. Type Ⅱ smaller fetuses and type Ⅲ larger fetuses were more prone to severe complications and should be closely monitored and given proactive preventive management after birth.

关键词

单绒毛膜双羊膜囊双胎 / 选择性胎儿生长受限 / 回顾性队列研究 / 妊娠结局

Key words

monochorionic diamniotic twin / selective intrauterine growth restriction / retrospective cohort study / pregnancy outcome

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基金资助

国家自然科学基金资助项目(82103924)