Goldman G A, Dicker D, Peleg D, Goldman J A
Department of Obstetrics and Gynecology, Golda Meir Medical Center (Hasharon Hospital) Petah Tikva, Israel.
Aust N Z J Obstet Gynaecol. 1989 Feb;29(1):9-12. doi: 10.1111/j.1479-828x.1989.tb02867.x.
The main complication in multiple gestation with more than two fetuses is prematurity, with its concomitant increase in perinatal mortality and morbidity. Clearcut indications as to management of these pregnancies are lacking, and the efficiency of elective cerclage is controversial. Twelve triplets and three quadruplets out of 27 multiple pregnancies were electively sutured and compared to 10 triplets and two quadruplets without this procedure. Otherwise, both groups were managed uniformly regarding bed-rest, beta-mimetic drugs and dexamethasone for the enhancement of fetal lung maturity. Mean duration of pregnancy in patients with cerclage was 35 weeks, significantly longer than those who did not undergo this procedure (30.7 weeks) (p < 0.01). Furthermore, in the former group, the mean neonatal weight was significantly higher (p < 0.01), mean Apgar scores were better, significantly lower rates of respiratory distress syndrome occurred (p < 0.05), perinatal mortality rate was significantly reduced (p < 0.01) and the mean hospitalization period was shorter (p < 0.025). It seems that elective cervical suture is a definite contribution to the successful management of multiple pregnancies with more than two fetuses.
怀有两个以上胎儿的多胎妊娠的主要并发症是早产，随之而来的是围产期死亡率和发病率的增加。对于这些妊娠的管理缺乏明确的指征，选择性宫颈环扎术的有效性存在争议。27例多胎妊娠中有12例三胞胎和3例四胞胎接受了选择性缝合，并与10例未进行该手术的三胞胎和2例四胞胎进行比较。除此之外，两组在卧床休息、使用β-拟交感神经药物和地塞米松以促进胎儿肺成熟方面的管理方式一致。接受环扎术的患者的平均妊娠时长为35周，显著长于未接受该手术的患者（30.7周）（p<0.01）。此外，在前一组中，新生儿平均体重显著更高（p<0.01），平均阿氏评分更好，呼吸窘迫综合征的发生率显著更低（p<0.05），围产期死亡率显著降低（p<0.01），平均住院时间更短（p<0.025）。看来选择性宫颈缝合术对成功管理怀有两个以上胎儿的多胎妊娠有一定作用。
