Yamashita Akiko, Ishii Keisuke, Taguchi Takako, Mabuchi Aki, Ota Shiyo, Sasahara Jun, Hayashi Syusaku, Mitsuda Nobuaki
J Perinat Med. 2014 Nov;42(6):769-75. doi: 10.1515/jpm-2014-0072.
The association between the planned delivery mode and adverse perinatal outcomes of monochorionic diamniotic (MCDA) twin pregnancies at ≥36 weeks' gestation was evaluated.
This retrospective cohort study included uncomplicated MCDA twin pregnancies delivered after 36 weeks' gestation during a 10-year period. Cases were classified into the trial of labor (TOL) or cesarean section (CS) group according to the planned delivery mode. The primary outcome was a composite of adverse outcomes for at least one twin, including intrauterine fetal death (IUFD) after 36 weeks, neonatal death, umbilical artery pH<7.1, 5-min Apgar scores<7, hypoxic ischemic encephalopathy (HIE), meconium aspiration syndrome (MAS), respiratory distress syndrome (RDS), or acute feto-fetal hemorrhage (AFFH). The relationship between outcomes and the planned delivery mode was evaluated using a multiple logistic regression analysis.
We included the 310 pregnancies delivered after 36 weeks' gestation. After excluding 15 patients, the final analysis included 295 MCDA pregnancies: 63% had delivered through TOL and 37% through CS. The incidences of composite adverse outcomes in the TOL and CS groups were 4.3% and 1.9%, respectively. No IUFD, neonatal death, MAS, RDS, or AFFH was observed; two infants in each group developed HIE. Adverse outcomes were not significantly associated with any risk factor, including delivery through TOL.
TOL may not influence the perinatal outcomes of MCDA twin pregnancies delivered at ≥36 weeks' gestation.
评估单绒毛膜双羊膜囊（MCDA）双胎妊娠≥36周时计划分娩方式与不良围产期结局之间的关联。
这项回顾性队列研究纳入了10年间孕36周后分娩的无并发症MCDA双胎妊娠。根据计划分娩方式将病例分为试产（TOL）组或剖宫产（CS）组。主要结局是至少一个胎儿的不良结局综合指标，包括36周后宫内胎儿死亡（IUFD）、新生儿死亡、脐动脉pH<7.1、5分钟阿氏评分<7、缺氧缺血性脑病（HIE）、胎粪吸入综合征（MAS）、呼吸窘迫综合征（RDS）或急性胎儿-胎儿出血（AFFH）。使用多元逻辑回归分析评估结局与计划分娩方式之间的关系。
我们纳入了310例孕36周后分娩的妊娠。排除15例患者后，最终分析纳入295例MCDA妊娠：63%通过TOL分娩，37%通过CS分娩。TOL组和CS组综合不良结局的发生率分别为4.3%和1.9%。未观察到IUFD、新生儿死亡、MAS、RDS或AFFH；每组有两名婴儿发生HIE。不良结局与任何危险因素均无显著关联，包括通过TOL分娩。
对于孕≥36周分娩的MCDA双胎妊娠，TOL可能不会影响围产期结局。
