Jhaveri Rujul Rashmin, Nadkarni Trupti K
Clinical Associate, Department of Obstetrics and Gynaecology, Surya Women and Child Care , Mumbai, Maharashtra, India .
Additional Professor, Department of Obstetrics and Gynaecology, Nowrosjee Wadia Maternity Hospital , Mumbai, Maharashtra, India .
J Clin Diagn Res. 2016 Dec;10(12):QC26-QC28. doi: 10.7860/JCDR/2016/21688.9112. Epub 2016 Dec 1.
With the advent of assisted reproductive techniques, multi-fetal pregnancies are on the rise. While caesarean section is the defined mode of delivery for triplets and higher order pregnancies, the picture for twin delivery is not so clear. While a trial for vaginal delivery is attempted, the second twin is considered vulnerable to complications. Whether this translates into worsened perinatal outcomes is not well defined.
To study the perinatal outcome and to identify the various factors influencing the perinatal outcome of second twin with respect to mode of delivery.
Data was collected from hospital birth records regarding the mode of delivery of viable twins (period of gestation >28 weeks) and outcome of second twin with respect to APGAR scores, NICU stay, neonatal morbidity and mortality, over a period of 12 months.
Of the 93 pairs of twins delivered, in 21(22.6%) pregnancies both twins were delivered vaginally, in 70(75.2%) pregnancies both were delivered by caesarean section and in 2 (1.8%) pregnancies 1 twin was delivered by vaginal route and 2 by caesarean. In the vaginal delivery group, 85.7% times both twins were in vertex position. In the caesarean group, vertex/non-vertex (38.57%) was the most common presentation followed by non-vertex /non-vertex (25.71%) and vertex/vertex (24.28%). Comparing the perinatal outcome of second twin in both groups, the odds for APGAR score ≤7 was 3.385 times (OR-3.384, 95% CI 1.2099- 9.4684, p=0.02) in the vaginal group compared to the caesarean group. There was no association (OR-1.054, 95% CI 0.3344- 3.3268, p=0.9) between neonatal morbidity of second twin compared to mode of delivery. All 3 perinatal deaths were in the vaginal group (all between 28-32 weeks of gestation).
There is an increased preference for caesarean delivery in twin pregnancies except in cases where both the twins are in vertex position and not associated with any other maternal or fetal complication. However, the caesarean mode of delivery does not influence neonatal morbidity in second twin, except when the 1 minute APGAR score is ≤7.
随着辅助生殖技术的出现，多胎妊娠呈上升趋势。虽然剖宫产是三胎及以上妊娠的既定分娩方式，但双胎分娩的情况并不那么明确。在尝试经阴道分娩时，第二个胎儿被认为易发生并发症。这是否会转化为围产期结局恶化尚不清楚。
研究围产期结局，并确定关于分娩方式影响第二个胎儿围产期结局的各种因素。
收集了12个月期间医院出生记录中有关存活双胎（孕周>28周）的分娩方式以及第二个胎儿的阿氏评分、入住新生儿重症监护病房情况、新生儿发病率和死亡率的数据。
在93对分娩的双胎中，21例（22.6%）妊娠的两个胎儿均经阴道分娩，70例（75.2%）妊娠的两个胎儿均通过剖宫产分娩，2例（1.8%）妊娠中1个胎儿经阴道分娩，2个胎儿经剖宫产分娩。在经阴道分娩组中，85.7%的情况是两个胎儿均为头位。在剖宫产组中，头位/非头位（38.57%）是最常见的胎位，其次是非头位/非头位（25.71%）和头位/头位（24.28%）。比较两组中第二个胎儿的围产期结局，与剖宫产组相比，经阴道分娩组中阿氏评分≤7的几率为3.385倍（OR-3.384，95%CI 1.2099-9.4684，p=0.02）。第二个胎儿的新生儿发病率与分娩方式之间无关联（OR-1.054，95%CI 0.3344-3.3268，p=0.9）。所有3例围产期死亡均发生在经阴道分娩组（均在妊娠28-32周之间）。
双胎妊娠中剖宫产的偏好增加，除非两个胎儿均为头位且无任何其他母体或胎儿并发症。然而，剖宫产分娩方式不影响第二个胎儿的新生儿发病率，除非1分钟阿氏评分≤7。
