Abstract
目的 降低双胎妊娠围产儿不良预后的发生率,探讨合理的双胎终止妊娠时间.方法对1993年1月到2003年10月十年期间在上海地区六家医院妇产科分娩的655例双胎妊娠进行回顾性分析,分别计算出各孕周大小胎儿出生体重的百分位数、小于孕龄儿(small for gestational age,SGA)和重度窒息的发生率.结果 1.整个孕期双胎妊娠中小胎儿出生体重的第50百分位数均明显落后于单胎胎儿,33周前大胎儿出生体重的第50百分位数与单胎胎儿接近,33周后差别逐渐增大,39周后大小胎儿出生体重与单胎相比差别更为显著.与单胎妊娠不同,双胎妊娠大胎儿在39周、小胎儿40周达最大出生体重(3073 g和2670 g),在此之后出生体重反而下降,41周时明显降低(2555 g和2303g,P＜0.05).2.双胎妊娠大小胎儿SGA发生率随孕龄的增加呈上升趋势,39周后上升幅度明显增加,41周达到最高(P＜0.05).3.39周后小胎儿重度窒息的发生率明显增加.结论39周后双胎妊娠胎儿出生体重呈下降趋势,SGA及小胎儿围产期重度窒息的发生率明显上升,因此双胎妊娠的分娩时间不应超过39周。
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