Bricelj Katja, Tul Natasa, Lasic Mateja, Bregar Andreja Trojner, Verdenik Ivan, Lucovnik Miha, Blickstein Isaac
J Perinat Med. 2016 Oct 1;44(8):899-902. doi: 10.1515/jpm-2015-0404.
To evaluate the relationship between respiratory morbidity in twins by gestational age, birth order and mode of delivery.
All twin deliveries at <37 weeks, registered in a national database, in the period 2003-2012 were classified into four gestational age groups: 33-36, 30-32, 28-29, and <28 weeks. Outcome variables included transient tachypnea of the newborn (TTN), respiratory distress syndrome (RDS) and need for assisted ventilation.
A total of 1836 twins were born vaginally, and 2142 twins were born by cesarean delivery, for a grand total of 3978 twins. TTN did not appear to be related to birth order and to the mode of delivery. In contrast, RDS was more frequent among the second born twins in the vaginal birth groups born at 30-36 weeks [odds ratio (OR) 2.5, 95% confidence interval (CI) 1.2-5.1 and OR 2.0, 95% CI 1.2-3.5 for 33-36 weeks and 30-32 weeks, respectively], whereas this trend was seen in the cesarean birth groups born earlier (OR 3.8, 95% CI 1.1-13.0 for 28-29 weeks). Cesarean delivery significantly increased the frequency of RDS in twin A as well as in twin B compared with vaginal birth, but only at gestational ages <30 weeks.
Mode of delivery and birth order have a gestational age dependent effect on the incidence of RDS.
评估双胞胎呼吸疾病发病率与胎龄、出生顺序及分娩方式之间的关系。
将2003年至2012年期间在国家数据库中登记的所有孕周<37周的双胞胎分娩分为四个胎龄组：33 - 36周、30 - 32周、28 - 29周和<28周。结局变量包括新生儿短暂性呼吸急促（TTN）、呼吸窘迫综合征（RDS）及辅助通气需求。
共有1836对双胞胎经阴道分娩，2142对双胞胎剖宫产，总计3978对双胞胎。TTN似乎与出生顺序及分娩方式无关。相比之下，在30 - 36周经阴道分娩的双胞胎中，第二出生的双胞胎RDS更常见[33 - 36周和30 - 32周的优势比（OR）分别为2.5，95%置信区间（CI）1.2 - 5.1和OR 2.0，95%CI 1.2 - 3.5]，而在更早的剖宫产分娩组中也可见此趋势（28 - 29周的OR为3.8，95%CI 1.1 - 13.0）。与经阴道分娩相比，剖宫产显著增加了双胞胎A和双胞胎B中RDS的发生率，但仅在孕周<30周时。
分娩方式和出生顺序对RDS的发生率有胎龄依赖性影响。
