Rydhström H, Cullberg G
Department of Obstetrics and Gynecology, University Hospital of Lund, Sweden.
J Perinat Med. 1990;18(1):45-50. doi: 10.1515/jpme.1990.18.1.45.
The purpose of this population based study on twins born in Sweden between 1961 and 1987 was to estimate the risk to the fetuses of becoming entangled during birth, and to identify those pregnancies with an increased risk for this rare complication. By using 3 separate questionnaires, 41 of 26,428 twin pregnancies with entanglement were identified. Twins in breech-vertex presentation (group A; 29 cases) were at significantly greater risk of entanglement (chi 2 = 168.3, p less than 0.001) than twins not in breech-vertex presentation (group B; 8 in vertex-vertex, 3 in breech-breech, and 1 in vertex-breech presentation). Known risk factors for entanglement in group A were intra-uterine growth retardation, a birth weight less than 2000 g, and antenatal fetal death. Intrapartum-neonatal mortality reached 38.9% in group A (median gestational week 36); and for group B, 8.3% (median gestational week 38). Entanglement during the study period occurred in 1 of 645 twin deliveries, on average. A vaginal delivery is proposed for women with twins in breech-vertex presentation, unless other risk factors leading to an increased risk for entanglement warrant abdominal delivery.
这项基于瑞典1961年至1987年出生的双胞胎人群的研究目的是评估胎儿在出生时发生缠绕的风险，并确定那些出现这种罕见并发症风险增加的妊娠情况。通过使用3份单独的调查问卷，在26428例双胞胎妊娠中识别出41例有缠绕情况。臀先露-头先露的双胞胎（A组；29例）发生缠绕的风险（卡方 = 168.3，p < 0.001）显著高于非臀先露-头先露的双胞胎（B组；8例头先露-头先露、3例臀先露-臀先露和1例头先露-臀先露）。A组中已知的缠绕风险因素包括宫内生长迟缓、出生体重低于2000g和产前胎儿死亡。A组的产时-新生儿死亡率达到38.9%（中位孕周36周）；B组为8.3%（中位孕周38周）。在研究期间，平均每645例双胞胎分娩中有1例发生缠绕。对于臀先露-头先露的双胞胎孕妇，建议进行阴道分娩，除非其他导致缠绕风险增加的风险因素需要行剖宫产。
