切换至 "中华医学电子期刊资源库"

中华产科急救电子杂志 ›› 2018, Vol. 07 ›› Issue (01) : 40 -47. doi: 10.3877/cma.j.issn.2095-3259.2018.01.009

所属专题: 文献

论著

单、双胎妊娠并发子痫前期不良妊娠结局的荟萃分析
区爱莲1, 严昕玥1, 温宇文1, 黄启涛2,(), 钟梅2   
  1. 1. 510515 广州,南方医科大学第一临床医学院
    2. 510515 广州,南方医科大学南方医院妇产科
  • 收稿日期:2017-10-27 出版日期:2018-02-18
  • 通信作者: 黄启涛
  • 基金资助:
    国家自然科学基金(81401208,81671466); 广东省自然科学基金(2015A030310025,2015A030313292); 广州市珠江科技新星人才项目(201710010016); 南方医院"杰青培育计划"(2016J008); 南方医科大学南方医院院长基金(2016B019); 全国大学生创新创业训练计划(201612121007)

Adverse pregnant outcomes of singleton and twin pregnancies complicated with preeclampsia: A meta-analysis

Ailian Ou1, Xinyue Yan1, Yuwen Wen1, Qitao Huang2,(), Mei Zhong2   

  1. 1. First clinical medical college of Southern Medical University, Guangzhou, 510515, China
    2. Department of Obstetrics, Southern Hospital of Southern Medical University, Guangzhou, 510515, China
  • Received:2017-10-27 Published:2018-02-18
  • Corresponding author: Qitao Huang
  • About author:
    Corresponding author: Huang Qitao, Email:
引用本文:

区爱莲, 严昕玥, 温宇文, 黄启涛, 钟梅. 单、双胎妊娠并发子痫前期不良妊娠结局的荟萃分析[J]. 中华产科急救电子杂志, 2018, 07(01): 40-47.

Ailian Ou, Xinyue Yan, Yuwen Wen, Qitao Huang, Mei Zhong. Adverse pregnant outcomes of singleton and twin pregnancies complicated with preeclampsia: A meta-analysis[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2018, 07(01): 40-47.

目的

探讨单、双胎妊娠并发子痫前期的孕妇与围产儿不良结局发病率差异。

方法

检索PubMed、Web of Science、中国生物医学文献数据库、中国学术文献总库、万方和维普中文数据库中2000年1月至2017年12月国内外发表的关于单、双胎妊娠并发子痫前期妊娠结局的研究。采用RevMan 5.3与Stata 12.0软件对资料进行荟萃分析,采用OR值及相应的95%CI评价不良结局与双胎妊娠并发子痫前期的相关性。

结果

纳入10篇文献,共692例双胎妊娠合并子痫前期,3101例单胎妊娠合并子痫前期。双胎妊娠合并子痫前期组发病率高于单胎妊娠合并子痫前期:胎盘早剥OR=2.16,95%CI为1.40~3.36;产后出血OR=2.90, 95%CI为2.03~4.15;心功能衰竭OR=3.73, 95%CI为2.10~6.63 ;肺水肿OR=2.76, 95%CI为1.04~7.27;剖宫产OR=2.27, 95%CI为1.58~3.26;胎膜早破OR=2.99, 95%CI为1.64~5.47;早产OR=6.24,95%CI为4.16~9.38,新生儿重症监护病房转入率OR=2.33, 95%CI为1.66~3.26。

结论

双胎妊娠合并子痫前期的不良妊娠结局包括胎盘早剥、产后出血、心功能衰竭、肺水肿、剖宫产、胎膜早破、早产和新生儿重症监护病房转入的发病率比单胎妊娠合并子痫前期高。

Objective

To investigate the morbidity of perinatal and maternal outcomes in singleton and twin pregnancies complicated by preeclampsia.

Methods

Published studies about pregnant outcomes in singleton and twin pregnancy complicated by preeclampsia were searched and screened in PubMed, Web of Science, SinoMed, Chinese Biological Medicine (CNKI), databases of Wanfang and VIP database of Chinese journal. Retrieval time from January 2000 to December 2017. The RevMan 5.3 and Stata 12.0 software were used for meta-analysis. The correlation between twin pregnancy complicated with preeclampsia and adverse pregnancy outcomes were analyze by Pooled odds ratio (OR) with 95% confidence interval (CI).

Results

There were 10 retrospective cohort studies, including 692 twin pregnancies complicated with preeclampsia and 3101 singleton pregnancies complicated with preeclampsia. Compared with the singleton pregnancies complicated with preeclampsia, adverse pregnant outcomes of twin pregnancies complicated with preeclampsia were increased, such as placental abruption (OR=2.16, 95%CI: 1.40-3.36), postpartum hemorrhage (OR=2.90, 95%CI: 2.03-4.15), heart failure (OR=3.73, 95%CI: 2.10-6.63), pulmonary edema (OR=2.76, 95%CI: 1.04-7.27), cesarean delivery (OR=2.27, 95%CI: 1.58-3.26), premature rupture of membrane (OR=2.99, 95%CI: 1.64-5.47), preterm delivery (OR=6.24, 95%CI: 4.16-9.38), the rates of newborn admitted to intensive care unit (OR=2.33, 95%CI: 1.66-3.26).

Conclusion

Compared to the singleton pregnancies complicated with preeclampsia, twin pregnancies complicated with preeclampsia increased the morbidity of placental abruption, postpartum hemorrhage, heart failure, pulmonary edema, cesarean delivery, premature rupture of membrane, preterm and the rates of newborn admitted to intensive care unit.

表1 纳入研究文献的基本情况
表2 录入荟萃分析文献的NOS量表文献质量评价结果(分)
表3 双胎子痫前期组高于单胎的不良结局
表4 双胎子痫前期组与单胎发病率无差异的不良结局
表5 两篇文章报道的不良结局
表6 一篇文章报道的不良结局
[1]
Sibai B, Dekker G, Kupferminc M. Pre-eclampsia [J]. Lancet, 2005, 365(9461): 785-799.
[2]
乔宠,杨小梅,林其德. 子痫前期的流行病学研究进展 [J]. 中国计划生育和妇产科,2013, 5(6):5-8.
[3]
Kuklina E, Ayala C, Callaghan W. Hypertensive disorders and severe obstetric morbidity in the United States [J]. Obstet Gynecol, 2009, 113(6): 1299-1306.
[4]
Francisco C, Wright D, Benkõ Z, et al. Hidden high rate of pre-eclampsia in twin compared with singleton pregnancy [J]. Ultrasound Obstet Gynecol, 2017, 50(1): 88-92.
[5]
杨孜,王伽略,黄萍,等. 重度子癎前期终末器官受累不平行性及其围产结局探讨 [J]. 中华围产医学杂志,2006, 9(1):10-14.
[6]
万淑梅,余艳红,黄莺莺,等. 妊娠期高血压疾病严重并发症的发生规律及其对母儿的影响 [J]. 中华妇产科杂志,2007, 42(8):510-514.
[7]
Martin J, Hamilton B, Ventura S, et al. Births: final data for 2011 [J]. Natl vital stat Rep, 2013, 62(1): 1-69.
[8]
王姗,罗方媛,何国琳,等. 131例双胎妊娠并发重度子痫前期的妊娠结局 [J]. 中华围产医学杂志,2013, 16(2):65-70.
[9]
匡丽云,汤雯婷,周燕媚,等. 单、双胎妊娠并发子痫前期临床分析 [J]. 中华产科急救电子杂志,2016, 5(1):40-44.
[10]
方根娟,张甦. 双胎妊娠并发重度子痫前期母儿结局分析 [J]. 中国妇幼保健,2009, 24(22):3069-3071.
[11]
沈晔,王文娟. 双胎妊娠并发子痫前期的临床分析 [J]. 中国医药指南,2015, 13(20):42-42,44.
[12]
郭宗艳,宋爱君,李爱云. 双胎妊娠合并重度子痫前期的妊娠结局分析及护理策略 [J]. 中国医学创新,2013,(16):49-51.
[13]
Sibai BM, Hauth J, Caritis S, et al. Hypertensive disorders in twin versus singleton gestations. National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units [J]. Am J Obstet Gynecol, 2000, 182(4): 938-942.
[14]
Connolly KA, Factor SH, Getrajdman CS, et al. Maternal clinical disease characteristics and maternal and neonatal outcomes in twin and singleton pregnancies with severe preeclampsia [J]. Eur J Obstet Gynecol Reprod Biol, 2016, 201: 36-41.
[15]
Henry DE, Mcelrath TF, Smith NA. Preterm severe preeclampsia in singleton and twin pregnancies [J]. J Perinatol, 2013, 33(2): 94-97.
[16]
Suzuki S, Igarashi M. Risk factors for preeclampsia in Japanese twin pregnancies: comparison with those in singleton pregnancies [J]. Arch Gynecol Obstet, 2009, 280(3): 389-393.
[17]
Connolly K, Getrajdman C, Factor S, et al. 632: Are twins with preeclampsia at greater risk for maternal and perinatal morbidity compared to singletons with preeclampsia at similar gestational ages? [J]. Am J Obstet Gynecol, 2013, 208(1): S268.
[18]
李晓菲,吴青青. 正常双胎妊娠孕妇左心结构、功能及子宫动脉血流参数纵向研究 [J]. 中国临床医学影像杂志,2016, 27(1):32-37.
[19]
Kuleva M, Youssef A, Maroni E, et al. Maternal cardiac function in normal twin pregnancy: a longitudinal study [J]. Ultrasound Obstet Gynecol, 2011, 38(5): 575-580.
[20]
Kametas NA, Mcauliffe F, Krampl E, et al. Maternal cardiac function in twin pregnancy [J]. Obstet Gynecol, 2003, 102(4): 806-815.
[21]
Bosio PM, Mckenna PJ, Conroy R, et al. Maternal central hemodynamics in hypertensive disorders of pregnancy [J]. Obstet Gynecol, 1999, 94(6): 978-984.
[22]
Thomsen JK, Foghandersen N, Jaszczak P. Atrial natriuretic peptide, blood volume, aldosterone, and sodium excretion during twin pregnancy [J]. Acta Obstet Gyneco Scand, 1994, 73(1): 14-20.
[23]
Kim M, Kim Y, Kim H, et al. Evaluation of left ventricular short- and long-axis function in severe mitral regurgitation using 2-dimensional strain echocardiography [J]. Am Heart J, 2009, 157(2): 345-351.
[24]
王雅楠,杨孜. 子痫前期患者胎盘早剥发病危险因素分析 [J]. 中华妇产科杂志,2010, 45(11):825-828.
[25]
范玲,黄醒华. 胎盘早剥漏诊原因分析 [J]. 中华围产医学杂志,1999, 2(2):86-88.
[26]
蔡素清,林邯枫. 晚期妊娠胎膜早破阴道分泌物培养结果与妊娠结局的相关性分析 [J]. 现代诊断与治疗,2013, 24(1):121-122.
[27]
钱海芬. 胎膜早破与阴道炎的相关性分析 [J]. 中华医院感染学杂志,2013, 23(10):2370-2371.
[28]
Sibai BM, Frangieh AY. Management of severe preeclampsia [J]. Curr Opin Obstet Gynecol, 1996, 8(2): 110-113.
[29]
蓝美菊. 细菌性阴道炎及衣原体感染与胎膜早破的关系 [J]. 中国医药指南,2012,(29):552-553.
[30]
中华医学会妇产科学分会产科学组. 胎膜早破的诊断与处理指南(2015) [J]. 中华妇产科杂志,2015, 50(1):161-167.
[31]
刘天娇. 妊娠期念珠菌性外阴阴道炎与胎膜早破及不良妊娠结局的相关性 [J]. 中国妇幼保健,2016, 31(20):4224-4226.
[32]
管菲,林建华. 早发型子痫前期的期待治疗 [J]. 中华围产医学杂志,2015, 18(11):873-876.
[33]
杨孜. 子痫前期多因素发病及多机制发病通路之综合征再认识 [J]. 中华医学杂志,2015, 95(1):7-9.
[1] 尹宏宇, 吴青青, 李晓菲. 颈后透明层和头臀长在妊娠11~13+6周双胎心脏畸形筛查中的价值[J]. 中华医学超声杂志(电子版), 2024, 21(03): 251-256.
[2] 谭芳, 杨娇娇, 范思涵, 叶彩玲, 纪学芹. 产前超声心动图在先天性血管环诊断中的价值[J]. 中华医学超声杂志(电子版), 2024, 21(01): 37-41.
[3] 李欣, 魏艺, 张娟, 张娟娟, 凌秀凤, 赵纯, 张媔秋. 高龄女性冻胚移植周期临床妊娠结局的影响因素分析[J]. 中华妇幼临床医学杂志(电子版), 2024, 20(03): 276-283.
[4] 薛静, 孙雅楠, 朱丽丽, 李淑红. 妊娠期急性脂肪肝孕产妇诊疗及其妊娠结局[J]. 中华妇幼临床医学杂志(电子版), 2024, 20(03): 312-321.
[5] 陈义思, 梁敏, 李红雨, 夏雪, 刘燕茜, 李晨曲, 王丹. 妊娠合并慢性肾病围产期多学科团队管理价值研究[J]. 中华妇幼临床医学杂志(电子版), 2024, 20(02): 133-139.
[6] 贾赛君, 张英, 万佳义. 妊娠合并亚临床甲状腺功能减退孕妇的妊娠结局[J]. 中华妇幼临床医学杂志(电子版), 2024, 20(02): 140-147.
[7] 蒋敏, 刘馨竹, 李大伟, 冯柏塨, 申传安. 点阵CO2激光联合其他非手术方式治疗痤疮瘢痕有效性的网状荟萃分析[J]. 中华损伤与修复杂志(电子版), 2024, 19(05): 429-439.
[8] 李海亮, 俞云, 张星星, 陈管洁, 刘玲, 谢剑锋, 常炜. 经鼻高流量氧疗在危重症患者气管插管过程中效果的荟萃分析[J]. 中华重症医学电子杂志, 2024, 10(03): 227-235.
[9] 胡淼, 杜丽丽, 张丽姿, 林琳, 张瑜亮, 古士锋, 古仲嘉, 赖思莹, 梁景英, 刘雨, 黄敏珊, 黄媛媛, 黄晴晴, 罗世君, 陈敦金. 体外受精/卵胞浆内单精子注射受孕患者胎盘植入分级及围产结局的研究[J]. 中华产科急救电子杂志, 2024, 13(03): 183-189.
[10] 刘文易, 高晓彤, 汤景, 麦卓瑶, 祝丽琼, 陈慧. 体外受精-胚胎移植妊娠合并绒毛膜下血肿患者妊娠结局的临床研究[J]. 中华产科急救电子杂志, 2024, 13(02): 93-99.
[11] 庄旭, 丁立, 许丽, 张宁, 张羽, 林建华. 慢性肾病孕妇肾脏超声异常与不良妊娠结局的相关性研究[J]. 中华产科急救电子杂志, 2024, 13(02): 100-105.
[12] 徐琦, 彭小芳, 杜涛, 王霞妹, 张蜀宁, 陈曼绮, 郭勤敏, 黄泽薇, 付帅. COL1A2基因变异致胎儿期及成年后成骨不全家系的相关研究[J]. 中华产科急救电子杂志, 2024, 13(02): 106-111.
[13] 王晓艳, 朱利平, 侯顺玉, 岳永飞. 椎管内分娩镇痛对B族溶血性链球菌阳性孕妇阴道分娩结局的影响[J]. 中华产科急救电子杂志, 2024, 13(02): 112-116.
[14] 张允耀, 王静, 范爱娟, 牟海萍. 超声诊断卵巢交界性肿瘤临床价值的荟萃分析[J]. 中华诊断学电子杂志, 2024, 12(02): 85-89.
[15] 王海珍, 马永明, 姚可盈. 尿激酶治疗结核性包裹性胸腔积液疗效的系统评价与荟萃分析[J]. 中华胸部外科电子杂志, 2024, 11(01): 53-61.
阅读次数
全文


摘要