Risk Factors And Clinical Characteristics Of Unbalanced Twin Development In Neonates

【Objective】With the development of assisted reproductive technology,the number of twin pregnancies is increasing.It is very important to summarize and analyze the clinical characteristics and prognosis of newborns in twin pregnancies.Especially in the clinical experience of many years,there are many clinical complications in twin pregnancies,such as low birth weight,long hospital stay,and poor prognosis High.To explore the occurrence rate of twin premature infants with discordant birth weight,adverse maternal and infant outcomes,and risk factors related to twin premature infants with discordant birth weight,in order to provide references for preventing the occurrence of twin premature infants with discordant birth weight in clinical practice and improvement of neonatal outcome.【Method】From January 2017 to June 2018,there were 11 453 pregnant women and 14 436newborns delivered in the Third Affiliated Hospital of Guangzhou Medical University,From January 2017 to June 2018,2912 cases of twin pregnant women and5824 cases of newborn were included among the pregnant women in the Third Hospital Affiliated to Guangzhou Medical University(Severe deformities and stillbirths have been eliminated).The difference of birth weight between the two newborns was more than 20%in the group with unbalanced twin development and less than 20%in the group with balanced twin development.According to the medical records,delivery records,newborn birth records and follow-up registration,the clinical data of pregnant women and newborns were recorded.The perinatal outcomes of the two groups were compared,and the risk factors of the two groups were analyzed.Independent sample t-test,χ2 test and stepwise logistic regression analysis were used for statistical analysis.【Results】1.From January 2017 to June 2018,a total of 11453 pregnant women and 14436newborns were delivered in hospital,the incidence of twin premature infants with discordant birth weight in 2912 cases pregnant woman and 5824 cases newborn of gemellary pregnancy from January 2017 to June 2018 in the third hospital affiliated to guangzhou medical college hospital.The incidence of twin imbalance was 3.54%(103/2912).The gender,classification,gestational age in two groups had no significant difference(P>0.05),and the birth body mass,length of hospital stay,cases less than the gestational age,the lowest body quality time in two groups had significant difference(P<0.05).2.Univariate and multivariate logistic regression analysis suggested that Age>30,gestational age≤35 weeks,gravidity≥2,BMI≤25 kg/m~2,with gestational diabetes mellitus and gestational hypertension,fetal classification(single chorionic amniotic membrane double embryo sac),twins heterosexual,blood albumin<35 g/L,triglyceride<1.50 mmol/L and bicarbonate≥20μmol/L were the influence factors of premature infants with discordant birth weight(P<0.05).Maternal living environment,use of assisted reproductive technology,education level,birth times≥2 times,blood leukocyte≥8.0 g/L、serum creatinine≥850 mmol/L、aspartate aminotransferase≥25U/L、alanine aminotransferase≥25 U/L were not risk factors of premature infants with discordant birth weight(P>0.05).3.The incidence of adverse outcomes of infection,excessive amniotic fluid,oligohydramnios,premature rupture of membranes,preterm delivery,and postpartum hemorrhage in the parturient group with imbalanced development of twins was 8.74%,11.65%,9.71%,17.48%,20.39%,and 8.74%,which was significantly higher than that in the balanced development of twins group,and the difference between the two groups was significant(P<0.05).One of the fetuses had incidence of fetal growth restriction,neonatal infectious pneumonia,neonatal asphyxia,fetal distress,neonatal hypoglycemia,hyperbilirubinemia,and fetal death in neonatal adverse outcomes was15.53%,23.30%,20.39%,13.59%,11.65%,24.27%,and 2.91%,significantly greater than that in the balanced twin development group,with significant differences between the two groups(P<0.05).The incidence of adverse outcomes of single chorionic double amniotic sac was significantly higher than that of single chorionic double amniotic sac and double chorionic double amniotic sac in the diparity group,and the difference between sanya group was significant(P<0.05).【Conclusion】1.The occurrence of twin imbalance is a multi factor and multi-stage process.Epidemiological studies have found many risk factors of twin imbalance,including pregnant women,fetus and genetic factors.This study shows that the factors that influence the development of twins are the age of the mother>30 years old,gestational age≤35 weeks,gestational times≥2 times,BMI≤25 kg/m2 before pregnancy,gestational diabetes,gestational hypertension,the classification of twins into single chorioamniotic sac and twin heterosis.2.Imbalance of twin pregnancy development increases the incidence of adverse outcomes of pregnant women and newborns,among which the incidence of adverse outcomes of one fetal growth restriction,neonatal infectious pneumonia,neonatal asphyxia,fetal distress,neonatal hypoglycemia,neonatal hyperbilirubinemia,and neonatal death is significantly higher than that of the balanced twin pregnancy group,which affects the hospitalization time of newborns.Therefore,it should be selected for consultation The diagnosis method with high efficiency should be carried out as early as possible.3.For relatively high age,number of pregnancy and produce more and too thin,merging,gestational hypertension,diabetes,twin pregnancy should pay close attention to maternal nutritional status during pregnancy,blood glucose,and high quality protein,high fiber was taken in the early weeks of pregnancy proper carbohydrate diet and exercise with the combination of a healthy lifestyle,prevent the happening of premature infants with discordant birth weight,avoid the occurrence of aderse outcome maternal and neonatal adverse outcomes.