Zhang Jun, Hamilton Brady, Martin Joyce, Trumble Ann
Division of Epidemiology, Statistics and Prevention Research, National Institute of Child Health and Human Development, National Institutes of Health/DHHS, Bethesda, MD, USA.
Am J Obstet Gynecol. 2004 Aug;191(2):470-6. doi: 10.1016/j.ajog.2004.03.002.
Delaying delivery of the remaining fetus(es) in a multifetal pregnancy is feasible in some cases. However, the impact of this procedure on infant survival is unclear.
We used the US 1995-1998 Matched Multiple Birth File. We identified 200 twin pregnancies in which the first twin was delivered between 17 and 29 weeks of gestation and the second twin was delivered 2 or more days later. We individually matched the delayed deliveries with 374 twin pregnancies in which the second twin was delivered on the same or next calendar day. Perinatal outcomes and infant survival were compared between the delayed and nondelayed twins.
Among the 200 pregnancies with delayed delivery, the mean gestational age at first delivery was 23 weeks and the median duration of delay was 6 days (ranging from 2-107 days). One week of delay in delivery was associated with an increase in infant birth weight of 131 g on average (95% CI: 115-147 g). Moreover, 56% of the delayed second twins survived to 1 year of age, whereas only 24% of the nondelayed second twins survived to 1 year of age (P <.001). However, 11% of the second twin in delayed delivery (95% CI: 6%-16%) experienced fetal death before 24 weeks.
Delayed delivery of the remaining fetus(es) before 30 weeks of gestation for 2 or more days was associated with improved infant survival.
在某些情况下，延迟多胎妊娠中其余胎儿的分娩是可行的。然而，该操作对婴儿存活的影响尚不清楚。
我们使用了美国1995 - 1998年匹配多胎出生档案。我们确定了200例双胎妊娠，其中第一胎在妊娠17至29周之间分娩，第二胎在2天或更长时间后分娩。我们将延迟分娩的情况与374例双胎妊娠进行个体匹配，在这些妊娠中，第二胎在同一日历日或次日分娩。比较了延迟分娩和未延迟分娩的双胞胎的围产期结局和婴儿存活率。
在200例延迟分娩的妊娠中，首次分娩时的平均孕周为23周，延迟的中位持续时间为6天（范围为2 - 107天）。分娩延迟1周平均与婴儿出生体重增加131克相关（95%可信区间：115 - 147克）。此外，56%的延迟分娩的第二胎存活至1岁，而未延迟分娩的第二胎中只有24%存活至1岁（P <.001）。然而，延迟分娩的第二胎中有11%（95%可信区间：6% - 16%）在24周前发生胎儿死亡。
在妊娠30周前将其余胎儿延迟分娩2天或更长时间与婴儿存活率提高相关。
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