Impact Of Chorionicity On Gestational Outcome In Twin Pregnancies

Background and purpose:Twin pregnancy,compared with single pregnancy,is more prone to induce a variety of obstetric complications,which leads to the poor pregnancy outcome.Therefore,twin pregnancy is a high-risk pregnancy.In recent years,with the rapid development of assisted reproductive technology(ART),the morbidity rate of twin pregnancy is significantly higher.More and more reports show that the morbidity of perinatal complications in monochodonic(MC)twin pregnancies is higher than that in dichorionic(DC)twin pregnancies,and with worse perinatal outcome in monochodonic(MC)twin pregnancies.In this paper,we reviewed the perinatal complications and maternal and fetal outcomes of different chorionic twin pregnancies in our hospital,and then discussed its clinical significance.Method:1.Research data: Through a retrospective comparative analysis on the delivery of 224 cases of twin pregnancy between January 1,2016 to January 31,2017 in the First Hospital of Jilin University hospital,judge their chorion,and,according to the character of chorion,divide the 224 cases into a group of 73 cases of MC twin pregnancies(71 cases of MCDA and 2 cases of MCMA)and a group of 151 cases of DC twin pregnancies(DCDA);respectively,compare the perinatal complications and perinatal pregnancy outcomes of the two groups of pregnant women.2.Statistical method: Use SPSS22.0 software to do statistical analysis of data,and make independent t test of the measurement data and make χ2 test for the counting data.If the theoretical frequency T<1,or n<40 in four grid table,then use the Fisher exact test;if 1≤T<5,and n>40,then use the correction formula of χ2 test of four-grid table.The above have statistical significance when P <0.05.Outcome:1.The impact of chorionicity on maternal perinatal complications: Comparing and analyzing the morbidity rate of different chorionic groups in premature rupture of membranes(ROPM),pregnancy induced hypertension(PIH),gestational diabetes mellitus(GDM),pregnancy of intrahepatic cholestasis(ICP),thyroid dysfunction during pregnancy,polyhydramnios,placenta previa,placental abruption,caesarean section and postpartum hemorrhage,the difference has no statistical significance(P> 0.05).2.The impact of chorionicity on the fetus: After comparing and analyzing the morbidity rate of discordant fetal growth and intrauterine fetal death with different chorion,it was found that the morbidity rate in MC group is respectively16.44%,6.61% and respectively 6.62%,2.32% in DC group,which has the statistical significance(P<0.05).After removing TTTS patients from MC group and comparing once more the morbidity rate of discordant fetal growth and intrauterine fetal death between the two groups,the statistical significance in both of them disappears(P>0.05).3.The impact of chorionicity on fetal miscarriage,premature birth and neonatal weight: After comparing and analyzing,with different chorion,twin miscarriage,premature(premature birth,early preterm birth and late preterm birth)and neonatal weight(average weight,low birth weight children,very low birth weight infant,extremdy low birth weight infant),it’s found that the preterm birth rate(12.32%,68.49%)in MC twins group is significantly greater than that in DC twins group(3.97%,51.66%),which has the statistical significance(P<0.05).Early preterm birth rate in MC group is higher than that in DC group and the difference has statistical significance.Late preterm birth rate in MC group is higher than that in DC group,but the difference has no statistical significance.Neonatal weight of MC group is obviously lower than that of DC group.And the morbidity rates of LBWI,VLBWI and ELBWI in MC group are higher than that in DC group and the difference has statistical significance(P<0.05).4.The impact of chorionicity on neonatal prognosis: After comparing and analyzing the newborns asphyxia(mild and severe)and rate of newborns transferred to NICU,it’s found that the morbidity in MC group is higher than that in DC group,and the difference has statistical significance(P<0.05).5.The impact of chorionicity on neonatal disease: After comparing and analyzing the newborns in MC group and DC group,it’s found that the morbidity rates of persistent patent ductus arteriosus(PDA),neonatal wet lung,respiratory distress syndrome(RDS),intracranial hemorrhage,neonatal malformations,preterm children retinopathy in MC group are significantly higher than those in DC group,and the difference has statistical significance(P<0.05).6.The impact of chorionicity on neonatal deaths: After comparing and analyzing the neonatal death rate between the two groups,it’s found that the morbidity rates in MC twins groups are respectively 8.90%,and 3.97% in DC group.The difference has statistical significance(P<0.05).After removing TTTS patients from MC group,the statistical significance between them disappears(P>0.05).Conclusions:1.Chorion has no significant effect on the occurrence of perinatal complications in pregnant women.2.Monochodonic twin pregnancy is a risk factor for abortion,premature delivery,early premature birth,low birth weight infants,RDS and neonatal disease.3.For monochodonic twin pregnancy,the rates of twins growth inconsistence,fetal death intrauterine and neonatal death are significantly higher than those in dichorionic twin pregnancy,and the difference has statistical significance.The specific complication of monochodonic twins-TTTS is a risk factor for the above morbidity rates.4.The chorionicity of twin pregnancy is closely related with the complication and perinatal outcome of perinatal infants.The prognosis of MCDA twin pregnancy is significantly worse than prognosis of DCDA twin pregnancy.5、The nature of twin pregnancy chorion should be clear-cut in early pregnancy.Monitoring and intervening for monochodonic twins during pregnancy are the key to improve the perinatal prognosis of twin pregnancy.