THE ORIGIN AND OUTCOME OF PRETERM TWIN PREGNANCIES
THE ORIGIN AND OUTCOME OF PRETERM TWIN PREGNANCIES
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DOI：
10.1016/0029-7844(94)00455-m
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发表时间：
1995-04-01
影响因子：
7.2
通讯作者：
COPPER, RL
中科院分区：
文献类型：
--
作者：
GARDNER, MO;GOLDENBERG, RL;COPPER, RL
目的：定义早产双胞胎的病因，并确定双胞胎早产和相关的发病率和mortals.Methods的贡献：3月的一角钱多中心早产和预防研究包括了33,873名妇女谁交付1982年至1986年，432（1.3%），其中交付双胞胎。妇女按早产原因和种族分类。新生儿按死产、新生儿死亡和各种短期发病率分类。第二个数据集来自一个中心，由体重1000 g或更少的婴儿组成，出生于1979-1991年，存活至1岁（n = 386，15%双胞胎）;这被用来确定双胞胎和单胞胎出生在相当的胎龄是否有类似的风险，为主要的发育障碍。在数据集中，54%的双胞胎早产，而单胞胎早产的比例为9.6%。在早产儿中，双胞胎的胎龄明显早于单胞胎。在所有出生的新生儿中，只有2.6%是双胞胎，但他们占所有早产儿的12.2%，占所有新生儿死亡的15.4%，占所有胎儿死亡的9.5%。自然分娩占双胞胎的54%，胎膜早破占22%，指示分娩占23%。在双胞胎中，44%的早产是由于母亲高血压，33%是由于胎儿窘迫或胎儿生长受限，9%是由于胎盘阻塞，7%是由于胎儿死亡。与胎龄相似的婴儿相比，双胞胎的体重较轻，但29周后的死亡率与单胞胎相当。在妊娠26-28周之间，双胞胎与单胞胎的死亡风险为1.6（95%置信区间1.1-2.5）。早产双胞胎的呼吸窘迫综合征、脑室内出血、坏死性小肠结肠炎或其他短期发病率并不比早产单胞胎明显更多。体重500-1000 g并存活1年的双胞胎有25%的严重发育障碍。然而，当胎龄得到控制，主要障碍率并不高于双胞胎比singletons.Conclusions：双胞胎占早产和相关的发病率和死亡率的不成比例的金额。此外，当早产双胞胎与早产单胞胎进行比较，并校正其胎龄，发病率是相似的。体重小于1000 g的早产双胞胎在1岁时的主要残疾患病率与早产单胞胎相比并没有增加。
Objective: To define the etiology of preterm twin births and determine the contribution of twin births to preterm birth and related morbidity and mortality.Methods: The March of Dimes Multicenter Prematurity and Prevention Study included a total of 33,873 women who delivered between 1982-1986, 432 (1.3%) of which delivered twins. Women were classified by reason for preterm birth and ethnicity. Neonates were classified as to stillbirth, neonatal death, and various short-term morbidities. A second data set from one center consisted of infants who weighed 1000 g or less, were born between 1979-1991, and survived to 1 year of age (n = 386, 15% twins); this was used to determine if twins and singletons born at comparable gestational ages have a similar risk for major developmental handicaps.Results: Of the deliveries in the data set, 54% of twins were preterm compared with 9.6% among singletons. Of those born preterm, twins were born at a significantly earlier gestational age than were singletons. Only 2.6% of all neonates born were twins, but they represented 12.2% of all preterm infants, 15.4% of all neonatal deaths, and 9.5% of all fetal deaths. Spontaneous labor accounted for 54% of twin births, premature rupture of membranes accounted for 22%, and indicated deliveries accounted for 23%. Of the indicated preterm births in twins, 44% were due to maternal hypertension, 33% to fetal distress or fetal growth restriction, 9% to placental abruption, and 7% to fetal death. Comparing infants of similar gestational age, twins weighed less, but had a mortality equivalent to that of singletons after 29 weeks. Between 26-28 weeks' gestation, the risk of mortality for twins versus singletons was 1.6 (95% confidence interval 1.1-2.5). Preterm twins did not have significantly more respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, or other short-term morbidity than did preterm singletons. Twins who weighed 500-1000 g and survived to 1 year had a 25% rate of major developmental handicaps. However, when gestational age was controlled, the rate of major handicaps was not higher in twins than in singletons.Conclusions: Twins accounted for a disproportional amount of preterm birth and associated morbidity and mortality. Also, when preterm twins were compared with preterm singletons and corrected for their gestational ages, the rates of morbidity were similar. Preterm twins weighing less than 1000 g did not have an increased prevalence of major handicaps at 1 year of age compared with preterm singletons.