双胎绒毛膜性与羊膜性对严重孕产妇发病率及产科结局的影响
基于美国2015-2021年住院分娩数据的回顾性队列研究，比较不同双胎类型与单胎的严重孕产妇发病率（SMM）。共纳入22506417例分娩住院，其中单胎占98.49%，双胎中MCDA占0.30%、DCDA占1.19%、MCMA占0.02%。MCDA和DCDA的复合SMM均高于单胎，且风险随绒毛膜性增加；MCMA样本量小，估计受限。
要点
- 双胎妊娠复合SMM风险高于单胎，且随绒毛膜性增加而升高。
- DCDA双胎出血相关SMM、子宫切除、剖宫产及重度子痫前期风险显著增加。
- MCMA双胎宫内死胎风险最高，但SMM估计受小样本限制。
核心结论
- 双胎妊娠的严重孕产妇发病率风险高于单胎，且风险因绒毛膜性不同而异，可为双胎妊娠的孕产妇咨询提供依据。
研究设计与样本
- 基于美国国家住院样本数据库（National Inpatient Sample）的群体回顾性队列研究，纳入2015至2021年美国分娩住院病例。
- 共纳入22,506,417例分娩住院，其中单胎22,157,332例（98.49%），MCMA 4005例（0.02%），MCDA 68,085例（0.30%），DCDA 268,330例（1.19%）。
- 通过ICD-10编码识别分娩住院、双胎类型及结局，SMM依据CDC标准定义（排除输血），采用多因素logistic回归估计调整比值比（aOR）及95%置信区间（CI）。
主要发现
- 复合SMM在MCDA双胎中发生率为1.9%（粗OR 2.54，95% CI 2.23-2.88），在DCDA双胎中为2.3%（粗OR 2.99，95% CI 2.82-3.17），均高于单胎的0.8%。
- DCDA双胎出血相关SMM的粗OR为4.26（95% CI 4.09-4.44），子宫切除粗OR为2.98（95% CI 2.57-3.45），剖宫产粗OR为6.51（95% CI 6.37-6.65），重度子痫前期粗OR为3.67（95% CI 3.57-3.77）。
- MCMA双胎宫内死胎风险最高，粗OR为22.49（95% CI 18.36-27.56），但该组样本量小，SMM估计受限。
临床怎么用
- 临床咨询双胎妊娠时，应告知不同绒毛膜性对应的严重孕产妇发病率风险差异。
- 对DCDA双胎需重点关注出血、子宫切除、剖宫产及重度子痫前期风险。
- 对MCMA双胎需特别警惕宫内死胎风险，但SMM风险评估需谨慎。
局限性
- MCMA双胎样本量小，相关估计受限。
- 研究为回顾性设计，基于行政数据库编码，可能存在编码偏倚。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
BACKGROUND: Twin gestations are associated with increased risks for adverse neonatal and perinatal outcomes. Chorionicity and amnionicity influence these risks however, their impact on severe maternal morbidity (SMM) remains incompletely understood. OBJECTIVES: To evaluate the risk of severe maternal morbidity and obstetric complications by twin type compared with singleton gestations. STUDY DESIGN: Population-based, retrospective cohort study of U.S. delivery hospitalizations from 2015 to 2021 using the National Inpatient Sample database. ICD-10 codes identified delivery hospitalizations, twin type, and outcomes. SMM was defined by the CDC criteria (excluding transfusion) and individual indicators were grouped by organ system. The primary objective was to evaluate SMM across twin types compared to singleton gestations, with secondary outcomes including specific SMM indicators and obstetrical complications. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were estimated using multivariate logistic regression. RESULTS: Of 22,506,417 delivery hospitalizations, 22,157,332 (98.49%) were singleton pregnancies, 4005 (0.02%) were monochorionic monoamniotic twins (MCMA), 68,085 (0.30%) monochorionic diamniotic twins (MCDA), and 268,330 (1.19%) dichorionic diamniotic twins (DCDA). Composite severe maternal morbidity (SMM) was more frequent in both MCDA (1.9%; crude OR: 2.54, 95% CI, 2.23-2.88) and DCDA (2.3%; crude OR: 2.99, 95% CI, 2.82-3.17) twin gestations compared with singletons (0.8%). Composite SMM increased with chorionicity among twin pregnancies, while estimates among MCMA twins were limited by small sample size. DCDA twins had significantly increased risks of hemorrhage-associated SMM (crude OR: 4.26, 95% CI, 4.09-4.44), hysterectomy (crude OR: 2.98, 95% CI, 2.57-3.45), cesarean delivery (crude OR: 6.51, 95% CI, 6.37-6.65), and preeclampsia with severe features (crude OR: 3.67, 95% CI, 3.57-3.77). MCMA twin pregnancies demonstrated the highest risk of intrauterine fetal demise compared with singleton gestations (crude OR: 22.49, 95% CI, 18.36-27.56). CONCLUSION: SMM risk is higher in twin gestations compared to singletons with risk varying by chorionicity. This is valuable information for maternal counseling in the setting of twin pregnancy. VIDEO ABSTRACT.
引用
- Baucom AM, Czarny HN, Toledo I, et al. Severe maternal morbidity and obstetrical outcomes by twin chorionicity and amnionicity. Am J Obstet Gynecol MFM. 2026. PMID: 42150693. doi:10.1016/j.ajogmf.2026.101993
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。