Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel.
Am J Perinatol. 2011 Jan;28(1):51-6. doi: 10.1055/s-0030-1262511. Epub 2010 Jul 6.
The appropriate time and the optimal mode of delivery of twins are still controversial. We assessed the effect of gestational age and the mode of elective delivery of twins on the occurrence of neonatal respiratory morbidity (NRM) and of maternal morbidity. This study included twins born beyond 35 weeks' gestation. NRM was defined as respiratory distress syndrome (RDS) and transient tachypnea of the newborn (TTN). Additionally, maternal complications related to the different modes of delivery were taken into account. Of 711 twin pregnancies (1422 liveborn neonates) included, 74 (5.2%) experienced NRM. Maternal age > 25 years, delivery at an earlier gestational age, and delivery by emergency cesarean section maintained statistical significance with NRM. From the maternal point of view, increased length of hospitalization ( P = 0.045) and the need for postoperative antibiotics ( P = 0.0065) were significantly higher following an emergency cesarean section than after an elective cesarean birth. The risk of NRM in twins born beyond 37 weeks' gestation is rather low. We suggest considering elective cesarean delivery at completion of 37 weeks. This can be performed safely in regard to NRM, the trade-off being reduced maternal morbidity associated with elective cesarean delivery.
双胎的适宜分娩时机和最佳分娩方式仍存在争议。我们评估了双胎妊娠的孕龄和选择性分娩方式对新生儿呼吸窘迫发生率（NRM）和产妇发病率的影响。本研究纳入了孕龄超过 35 周的双胎妊娠。NRM 定义为呼吸窘迫综合征（RDS）和新生儿短暂性呼吸急促（TTN）。此外，还考虑了与不同分娩方式相关的产妇并发症。在纳入的 711 例双胎妊娠（1422 例活产新生儿）中，有 74 例（5.2%）发生了 NRM。NRM 与产妇年龄>25 岁、更早的孕龄分娩和急诊剖宫产分娩有关，且具有统计学意义。从产妇的角度来看，急诊剖宫产分娩后住院时间延长（P=0.045）和需要术后抗生素治疗（P=0.0065）的风险显著高于选择性剖宫产分娩。孕龄超过 37 周的双胎发生 NRM 的风险相当低。我们建议考虑在孕龄满 37 周时进行选择性剖宫产分娩。考虑到 NRM，这可以安全进行，而选择性剖宫产分娩的风险是与产妇发病率降低相关的。
