Quintana Eider, Burgos Jorge, Eguiguren Nekane, Melchor Juan Carlos, Fernández-Llebrez Luis, Martínez-Astorquiza Txantón
Department of Obstetrics and Gynaecology, Cruces University Hospital, School of Medicine, University of the Basque Country, Biscay, Spain.
J Matern Fetal Neonatal Med. 2013 Mar;26(4):407-11. doi: 10.3109/14767058.2012.733752. Epub 2012 Oct 30.
To analyze morbidity and mortality in twin pregnancies as a function of the type of delivery and chorionicity.
Retrospective cohort study.
Analysis of the type of delivery, intertwin time interval, and perinatal variables of >1000 twin deliveries during a 10-year period.
Influence of delivery type and chorionicity on perinatal outcome.
The rate of cesarean sections was 42.4%. No differences were found as a function of chorionicity or as a function of presentation of the second twin. Cesarean sections were performed after vaginal delivery of the first twin in 1.8% of cases, being more common if the second baby was in a non-cephalic presentation (6.9% vs. 0.4%, p < 0.05). The average twin-to-twin delivery time interval was longer in the cases where the second had a cephalic presentation (8.26 ± 7.75 min vs. 6.81 ± 5.97 min, p < 0.05). The umbilical artery pH was lower the longer the interval between the birth of the twins, both in monochorionic and dichorionic.
According to the results, vaginal delivery is as safe as elective caesarean section in twin pregnancies where the first twin is in cephalic presentation and the intrapartum management should not vary due to chorionicity.
分析双胎妊娠的发病率和死亡率与分娩类型及绒毛膜性的关系。
回顾性队列研究。
分析10年期间1000多例双胎分娩的分娩类型、双胎间隔时间及围产期变量。
分娩类型和绒毛膜性对围产期结局的影响。
剖宫产率为42.4%。未发现其与绒毛膜性或第二个胎儿的胎位有关。1.8%的病例在第一个胎儿经阴道分娩后进行了剖宫产，如果第二个胎儿为非头位则更常见（6.9%对0.4%，p<0.05）。第二个胎儿为头位时，双胎分娩的平均间隔时间更长（8.26±7.75分钟对6.81±5.97分钟，p<0.05）。双胎出生间隔时间越长，单绒毛膜和双绒毛膜双胎的脐动脉pH值越低。
根据结果，在第一个胎儿为头位的双胎妊娠中，阴道分娩与选择性剖宫产一样安全，产时管理不应因绒毛膜性而有所不同。
