Pestana Inês, Loureiro Teresa, Almeida Amélia, Rocha Ilda, Rodrigues Rosa Maria, Rodrigues Teresa
Department of Obstetrics and Gynaecology, Hospital de S. João, Porto, Portugal.
J Reprod Med. 2013 Jan-Feb;58(1-2):15-8.
To assess whether vaginal delivery increases the risk of adverse neonatal outcome among uneventful monochorionic diamniotic twin pregnancies.
We conducted a retrospective controlled cohort study on 112 uneventful monochorionic diamniotic twin pregnancies at > or = 34 weeks' gestation. The outcomes of 52 monochorionic diamniotic twins delivered vaginally were compared with those of 172 monochorionic diamniotic twins delivered by cesarean section.
Five babies (2.9%) in the cesarean section group had a 5-minute Apgar score < 7 and needed orotracheal intubation, whereas in the vaginal delivery group no 5-minute Apgar score < 7 or orotracheal intubation occurred (p = 0.002). Delivery by cesarean section presented higher rates of admission to neonatal intensive care unit (62 out of 172 babies delivered by cesarean section compared to 3 out of 52 babies delivered vaginally, p < 0.001). There were no cases of intrapartum twin-to-twin transfusion syndrome or neonatal death at time of hospital discharge in either group.
Vaginal delivery appears to be a good management option in uneventful monochorionic diamniotic twin pregnancies after 34 weeks' gestation.
评估在无并发症的单绒毛膜双羊膜囊双胎妊娠中，阴道分娩是否会增加不良新生儿结局的风险。
我们对112例孕34周及以上的无并发症单绒毛膜双羊膜囊双胎妊娠进行了一项回顾性对照队列研究。将52例经阴道分娩的单绒毛膜双羊膜囊双胎的结局与172例剖宫产分娩的单绒毛膜双羊膜囊双胎的结局进行比较。
剖宫产组有5名婴儿（2.9%）5分钟Apgar评分<7，需要进行口气管插管，而阴道分娩组未出现5分钟Apgar评分<7或口气管插管的情况（p = 0.002）。剖宫产分娩的新生儿重症监护病房收治率更高（剖宫产分娩的172例婴儿中有62例，而阴道分娩的52例婴儿中有3例，p < 0.001）。两组均无产时双胎输血综合征病例或出院时新生儿死亡病例。
对于孕34周后的无并发症单绒毛膜双羊膜囊双胎妊娠，阴道分娩似乎是一种较好的处理方式。
