From the Departments of Pediatrics and Medicine and Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, California; and the Departments of Pediatrics and Obstetrics & Gynecology, Stanford University, Stanford, California.
Obstet Gynecol. 2011 Nov;118(5):1095-1101. doi: 10.1097/AOG.0b013e3182318651.
To estimate trends and risk factors for cesarean delivery for twins in the United States.
This was a cross-sectional study in which we calculated cesarean delivery rates for twins from 1995 to 2008 using National Center for Health Statistics data. We compared cesarean delivery rates by year and for vertex compared with breech presentation. The order of presentation for a given twin pair could not be determined from the available records and therefore analysis was based on individual discrete twin data. Multivariable logistic regression was used to estimate independent risk factors, including year of birth and maternal factors, for cesarean delivery.
Cesarean delivery rates for twin births increased steadily from 53.4% to 75.0% in 2008. Rates rose for the breech twin category (81.5%-92.1%) and the vertex twin category (45.1%-68.2%). The relative increase in the cesarean delivery rate for preterm and term neonates was similar. After risk adjustment, there was an average increase noted in cesarean delivery of 5% each year during the study period (risk ratio 1.05, 95% confidence interval 1.04-1.05).
Cesarean delivery rates for twin births increased dramatically from 1995 to 2008. This increase is significantly higher than that which could be explained by an increase in cesarean delivery for breech presentation of either the presenting or second twin.
估计美国双胞胎剖宫产的趋势和风险因素。
这是一项横断面研究，我们使用国家卫生统计中心的数据，计算了 1995 年至 2008 年双胞胎的剖宫产率。我们比较了不同年份和头位与臀位分娩的剖宫产率。由于可用记录无法确定给定双胞胎的分娩顺序，因此分析基于单个离散的双胞胎数据。多变量逻辑回归用于估计剖宫产的独立风险因素，包括出生年份和产妇因素。
2008 年，双胞胎剖宫产率从 53.4%稳步上升至 75.0%。臀位双胞胎的剖宫产率（81.5%-92.1%）和头位双胞胎的剖宫产率（45.1%-68.2%）均有所上升。早产儿和足月儿剖宫产率的相对增加相似。风险调整后，研究期间每年剖宫产率平均增加 5%（风险比 1.05，95%置信区间 1.04-1.05）。
1995 年至 2008 年，双胞胎剖宫产率显著增加。这一增长明显高于因头位或第二胎臀位分娩而导致的剖宫产率的增长。
