Study On Clinical Features Of Twin Pregnancy And Hypertensive Disorders Of Pregnancy

Objective:This study focused on the incidence,risk factors,different ultrasound indicators and maternal and fetal outcomes of HDP in twin pregnancy,in order to provide a basis for the perinatal management of pregnant women with hypertensive disorders of pregnancy.Data and methods:In this study,52,478 singleton pregnant women who met the incluison criteria in obstetrics hospitalized dilivery in Northwest women’s and children’s Hospital from January 2018 to January 2020 were collected,including 1687 singleton pregnant women with HDP.1619 twin pregnant women who met the inclusion criteria were selected as the research subjects.According to whether they were complicated with HDP,the subjects were divided into twins complicated with HDP,referred to as the twins HDP group(215 cases)and twins without HDP.The disease group,referred to as the twins non-HDP group(1404 cases),compared the basic data,laboratory indicators,pregnancy complications,pregnancy outcome and neonatal outcomes of the two groups of pregnant women.Statistical software SPSS 26.0 was used to analyze the collected clinical data.Results:1.The incidence of HDP in twins was 13.3%,and the incidence of HDP in singles was3.2%.In twin pregnancies,monochodonic diamnionic and dichorionic diamnionic incidence rates were 13.0%(42/322)and 13.3%(173/1297),respectively.2.Pregnancy weight gain and pre-pregnancy BMI(Body mass index,BMI)values in the twin HDP group were higher than those in twin non-HDP group.The twin HDP group was higher than the twin non-HDP group in terms of vitro assisted reproduction,medication history(aspirin,heparin,nifedipine),previous adverse pregnancy,and famliy history of hypertension,and the difference was statistically significant(P < 0.05).Compared with the twin non-HDP group,the proportion of pregnancy termination in uterine delivery was higher than that in the twin non-HDP group,and the difference was statistically significant(P < 0.05).3.High pre-pregnancy BMI,medication history(aspirin,heparin,nifedipine)during pregnancy,and family history of hypertension were the risk factors for hypertensive disorders in twin pregnancy,and the difference was statistically significant(P < 0.05).4.Compared with various ultrasounds and electrocardiograms of twin pregnancy women,cardiac B-ultrasound in twin HDP group(reduced left ventricular diastolic function,pericardial effusion,large left atrium and left ventricle,a small amount of aortic valve regurgitation,a small amount of mitral valve regurgitation),The incidence rate was significantly higher than that the twin non-HDP group,and the difference was statistically significant(P < 0.05).The twin HDP group had a higher incidence of sinus tachycardia and bradycardia than that of the twin non-HDP,and the difference was statistically significant(P < 0.05).The incidence rate of kidney problems(calculi,hydrocephalus,etc.)in twin non-HDP group was higher than that in that of twin HDP group,and the difference was statistically significant(P < 0.05).5.The incidence of pregnancy anemia,Intrahepatic cholestasis of pregnancy,hypothyroidism and hypoproteinemia in the twin HDP group was higher than that in the twin non-HDP group,and the difference was statistically significant(P <0.05).The incidence of placenta previa in twin non-HDP group was higher than that in twin HDP group,and the difference was statistically significant(P < 0.05).6.Placental disease examination and fundus examination: the formation of placental hematoma and hyperemia in the twin HDP group was higher than that in the twin non-HDP group.Analysis of fundus examination of twin pregnant women with different chorionic HDP showed that the incidence of retinopathy in dichorionic diamnionic group was higher than that monochodonic diamnionic group,and the difference was statistically significant(P < 0.05).7.The twin HDP group had lower body weight and Apgar score at the first minute,with statistical significance(P < 0.05);The incidence rate of neonatal hospitalized days and NICU days in the twin HDP group was significantly higher than that in the twin non-HDP group,and the difference was statistically significant(P < 0.05).The incidence rates of neonatal respiratory distress syndrome,neonatal jaundice,neonatal infections,neonatal hypoglycemia,neonatal anemia,neonatal intracranial hemorrhage and neonatal retinopathy in the twin HDP group were higher than those in the non-HDP group,and the difference was statistically significant(P < 0.05).Conclusion:1.The incidence of hypertensive disorders of pregnancy in twin pregnancy is higher than that in singleton pregnancy.There is no significant difference in the incidence of hypertensive disorders of pregnancy in different chorionic twins,and there is no significant difference in the classification of hypertensive disorders of pregnancy in different chorionic twin pregnancy.2.High pre-pregnancy BMI,medication history(aspirin,heparin,nifedipine)during pregnancy,and family history of hypertension were the risk factors for hypertensive disease in pregnancy of twins.3.Hypoproteinemia,increased D-dimer,decreased fibrinogen,and lower serum cystatin C level in twin HDP pregnant women were associated with placental damage.The rate of abnormal cardiac B-ultrasound was higher in pregnant women with twin HDP.4.The higher proportion of adverse neonatal outcomes and complications in pregnant women with twin HDP may be related to hypertensive disorders of pregnancy.