Nwankwo T O, Aniebue U U, Ezenkwele E, Nwafor M I
Department of Obstetrics and Gynaecology, University of Nigeria, Enugu Campus, Enugu, Nigeria.
Niger J Clin Pract. 2013 Oct-Dec;16(4):490-5. doi: 10.4103/1119-3077.116895.
The study aims to determine the differences in maternal and perinatal outcomes between caesarean and vaginal deliveries and the factors affecting vaginal delivery in twin pregnancy.
An observational study to audit twin pregnancies delivered at the University of Nigeria Teaching Hospital between 2002 and 2008. Clinical observations were entered into a questionnaire immediately after the delivery of the women and the mothers and their babies were followed up until the end of the puerperium.
There were 5298 deliveries within the study period, out of which 117 were twin deliveries. This gives a twinning rate of 22 per 1000 deliveries. The mean age of the mothers was 30 ± 5.9 years. Twenty-five (21.4%) women were admitted into the hospital for preterm labor. The average gestational age of admission was 32 ± 5.8 weeks and the average duration of hospital stay for preterm labor was 12.6 ± 9.1 days. Other pregnancy complications observed were severe hypertension (14.5%, anemia (9.4%), postpartum hemorrhage (8.5%), puerperal fever (5.1%), abruptio placentae, and diabetic mellitus (2.7%). Fifty-nine women (50.4%) had vaginal deliveries, 5 (4.3%) had vaginal delivery of the leading twin and caesarean delivery of the retained second twin while 53 women (45.3%) were delivered by caesarean section. Forty-eight (41%) women had preterm delivery. Vaginal deliveries were more common than caesarean section among patients that were unbooked than booked P = 0.047 (OR 2.26, 95%CI:0.93-5.53) and those that had cephalic presentation of the leading twin, P = 0.0002 (OR = 4.7 95% CI:2.6-8.2). Vaginal delivery tended toward statistical significance when the fetal weight of the leading twin was 1.5 to 2.5 kg, P = 0.09. The commonest indications for caesarean section were abnormal lies and presentations and hypertension in pregnancy.Two-hundred and seventeen (92.7%) out of a total of 234 fetuses that were delivered in this study were live births and 17 (7.3%) still births. The rate of new born admissions in twin 1 was however higher in those delivered by Caesarean section (39.6%) than those delivered vaginally (29.7%). Indications for admissions into the special baby care units were; prematurity 33 (40.2%), birth asphyxia 15 (18.3%), low birth weight 12 (14.6%), neonatal jaundice 10 (12.2%), and twin-twin transfusion 4 (4.9%). There was a higher rate of early neonatal death in both vaginally delivered twin 1 (9.4%) and twin 2 (11.9%) than those delivered by Caesarean section, 3.8 and 3.5%, respectively.
Cephalic presentation of the leading twin, birth weight less than 2.5 kg, and unbooked women presenting in advanced labor predisposed to vaginal delivery in twin pregnancies. There was however increased risk of still birth and early neonatal deaths especially for the leading twin in vaginal deliveries in unbooked women.
本研究旨在确定剖宫产与阴道分娩的孕产妇及围产期结局差异，以及双胎妊娠中影响阴道分娩的因素。
一项观察性研究，对2002年至2008年在尼日利亚大学教学医院分娩的双胎妊娠进行审计。妇女分娩后立即将临床观察结果录入问卷，并对母亲及其婴儿进行随访，直至产褥期结束。
研究期间共分娩5298例，其中双胎分娩117例。双胎率为每1000例分娩中有22例。母亲的平均年龄为30±5.9岁。25名（21.4%）妇女因早产入院。入院时的平均孕周为32±5.8周，早产的平均住院时间为12.6±9.1天。观察到的其他妊娠并发症包括重度高血压（14.5%）、贫血（9.4%）、产后出血（8.5%）、产褥热（5.1%）、胎盘早剥和糖尿病（2.7%）。59名妇女（50.4%）经阴道分娩，5名（4.3%）先娩出的双胎经阴道分娩，留存的第二个双胎经剖宫产分娩，53名妇女（45.3%）行剖宫产。48名（41%）妇女早产。未预约的患者中，阴道分娩比剖宫产更常见，P = 0.047（OR 2.26，95%CI：0.93 - 5.53）；先娩出的双胎为头位的患者中，阴道分娩也更常见，P = 0.0002（OR = 4.7，95%CI：2.6 - 8.2）。当先娩出的双胎胎儿体重为1.5至2.5 kg时，阴道分娩有统计学意义倾向，P = 0.09。剖宫产最常见的指征是胎位异常和妊娠高血压。本研究中分娩的234例胎儿中，217例（92.7%）为活产，17例（7.3%）为死产。然而，剖宫产分娩的双胎1新生儿入院率（39.6%）高于阴道分娩的双胎1（29.7%）。入住特殊婴儿护理病房的指征为：早产33例（40.2%）、出生窒息15例（18.3%）、低出生体重12例（14.6%）、新生儿黄疸10例（12.2%）、双胎输血4例（4.9%）。阴道分娩的双胎1（9.4%）和双胎2（11.9%）早期新生儿死亡率均高于剖宫产分娩的双胎1和双胎2，分别为3.8%和3.5%。
先娩出的双胎为头位、出生体重小于2.5 kg以及未预约且临产后入院的妇女，双胎妊娠时更倾向于阴道分娩。然而，未预约的妇女阴道分娩时，死产和早期新生儿死亡的风险增加，尤其是先娩出的双胎。
