بررسی عوامل خطر و پیامد حاملگی های دوقلویی با توجه به تفاوت وزن تولد میان دو نوزاد

نوع مقاله: اصیل پژوهشی

نویسندگان

1 - استادیار زنان و زایمان، دانشکده پزشکی، دانشگاه علوم پزشکی گیلان

2 - دانشیار میکروبیولوژی، دانشکده پزشکی، دانشگاه علوم پزشکی گیلان

3 استادیار زنان و زایمان، دانشکده پزشکی، دانشگاه علوم پزشکی گیلان

چکیده

مقدمه: افزایش غیر معمول تولدهای چندقلویی یک مشکل بهداشتی عمومی است زیراکه شیوع عوارض بارداری،
مرگومیر مادری، جنینی و نوزادی ، زایمان زودرس و پیامدهای جنینی و نوزادی ناشی از آن در حاملگی دو قلویی
نسبت به تک قلویی از تریمستر اول تا زمان زایمان بالاتر است. یکی از عوارض مهم در حاملگی های دوقلویی
ناهماهنگی وزن قل ها است که خود میتواند به عنوان عامل موثری در افزایش خطر پیامدهای نامطلوب دوقلویی،
مرگومیر و عدم توانایی در مراحل بعدی زندگی نوزاد مطرح شود.
روش کار: این مطالعه توصیفی تحلیلی که در طی آن پرونده 667 زایمان دوقلویی که بین سالهای 1376 - 1384 در
بیمارستانهای الزهرا و رسول اکرم رشت انجام شده بود مورد بررسی قرار گرفتند. با توجه به تفاوت وزن تولد بین قل
ها، نمونهها در دو گروه < 20% و ≥ 20% دسته بندی شدند. سپس فراوانی فاکتورهای موثر بر عدم تطابق وزن هنگام
تولد نظیر سن، مرتبه زایمانی مادر، پره اکلامپسی-اکلامپسی و پیامدهایی همچون زایمان زودرس، پرزانتاسیونهای
غیرسفالیک-سفالیک و سزارین در این دو گروه مورد مقایسه قرار گرفتند. اطلاعات جمع آوری شده توسط نرم افزار12
SPSS و آزمونهای آماری کای دو و تی تست مورد تجزیه و تحلیل و پردازش قرار گرفتند.
نتایج: از کل 667 زایمان دوقلویی در این سالها 78/4% دارای تطابق وزن و 21/6% فاقد تطابق وزن بودند. بین عدم
تطابق وزن حین تولد با زایمان زودرس و پرزانتاسیونهای غیر سفالیک – سفالیک ارتباط آماری معنی داری مشاهده
شد (P<0.05). اما میان سن، مرتبه زایمانی مادر، پره اکلامپسی- اکلامپسی و سزارین با عدم تطابق وزن حین تولد
ارتباطی آماری معنی داری بدست نیامد.
نتیجه گیری: نتایج حاصل از این مطالعه حاکی از همراهی عدم تطابق وزن دوقلویی با زایمان زودرس و
پرزانتاسیونهای غیر سفالیک میباشد. از این رو حاملگی چند قلویی بخصوص در شرایط عدم تطابق وزن هنگام
تولد به عنوان حاملگی پرخطر نیازمند بررسی و توجه ویژه جهت تشخیص، پایش و مراقبت دقیق دوران بارداری و
زایمان و نوزادی می باشد. 

کلیدواژه‌ها


عنوان مقاله [English]

Assessment of Risk Factors and Outcomes of Twin Pregnancies with Weight Discordance

نویسندگان [English]

  • Mandana Mansour Ghanaie 1
  • Kambiz Forghan Parast 2
  • Nader Esmaeil Pour 3
1 Assistant Professor of Obstetrics & Gynecology, Faculty of Medicine, Gillan University of Medical Sciences, Gillan, Iran
2 Associate Professor of Microbiology, Faculty of Medicine, Gillan University of Medical Sciences, Gillan, Iran
3 Assistant Professor of Obstetrics & Gynecology, Faculty of Medicine, Gillan University of Medical Sciences, Gillan, Iran
چکیده [English]

Introduction: Unusual increase of multifetal pregnancy is a public health problem. The prevalence of complications during pregnancy, maternal mortality, preterm labor, and fetal and neonatal complications in twin pregnancy is more than single pregnancy. Fetuses’ weight discordance is one of the important complications that may increase the unpleasant consequences of twin pregnancies such as the risk of fetal and neonatal mortality and disability.
 
Methods and Material: In this analytical study all the archived files (667) of twin pregnancies delivered during 1997-2005 in Alzahra and Rasoul Akram hospitals in Rasht city (north of Iran) were studied. Birth weight differences of the twins were stratified into the following groups: discordant twins (birth weight differences ≥20%) and concordant twins (birth weight differences<20%). Then the frequency of risk factors such as maternal age, parity, pre-eclampsia, and the outcomes such as preterm labor, non-cephalic- cephalic presentation, and cesarean delivery were compared in these groups. The data were analyzed by using the SPSS software version 12. X² and t tests were used to compare between groups.
 
Results: Of thetotal 667 twin deliveries, 78.4% were concordant and 21.6% were discordant. There was significant correlation between discordance and preterm labor and non cephalic- cephalic presentation (p<0.05). But there was not significant correlation between discordance and maternal age, parity, preeclampsia, and cesarean delivery.
 
Conclusion: Twin pregnancy with weight discordance is a very high risk pregnancy, which can be accompanied by non cephalic- cephalic presentation and preterm labor. It needs particular attention for detection and monitoring. Regular prenatal visits should be arranged in these pregnancies.

کلیدواژه‌ها [English]

  • Twins
  • weight Discordance
  • Preterm Labor
  • Preeclampsia
  • Cesarean section
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