Fill Malfertheiner S, Weigl M, Dudakova A, Seelbach-Göbel B
Department of Obstetrics and Gynecology, Clinic St. Hedwig, Hospital of the Merciful Brothers, University Medical Center Regensburg, Steinmetzstrasse 1-3, 93049, Regensburg, Germany.
Arch Gynecol Obstet. 2018 Jan;297(1):61-69. doi: 10.1007/s00404-017-4559-6. Epub 2017 Oct 10.
Since the late 1990s, controversies came up concerning the mode of delivery for multiples births. The twin birth study indicated no difference in maternal and fetal outcome between planned vaginal delivery and planned caesarean section, but did not analyze the influence of maternal and fetal characteristics or the obstetric management in vaginal birth. The purpose of this study is to analyze these parameters regarding fetal outcome.
A large-scale retrospective analysis of twin births (n = 1.444) was performed at a university medical center. The analysis included pregnancy, delivery, and maternal and fetal parameters, including pH and base excess (BE) differences between the first- and second-born twin (delta pH, delta BE).
Delta pH correlated significantly with the birth interval for various positions of twins in the womb (p < 0.05). The longer the birth interval, the greater the delta pH with a lower pH of the second twin. Delta BE values were significantly correlated with the birth interval for a combination of twins in cephalic and breech presentation. Furthermore, it could be shown that higher differences in birth weight between the first/second twin are associated with higher delta pH, higher delta BE values (all p < 0.05). We found significantly decreasing delta pH values in vaginal deliveries over secondary and, finally, primary caesarean sections (p < 0.001).
We conclude a vaginal delivery of twin appears safe if experienced staff monitor birth weight discrepancies, birth interval, and blood values consequently. A good outcome also for the second twin delivered spontaneously is nevertheless feasible if experienced staff is available.
自20世纪90年代末以来，关于多胎分娩的方式出现了争议。双胎分娩研究表明，计划阴道分娩和计划剖宫产在母婴结局方面没有差异，但未分析母婴特征或阴道分娩时产科管理的影响。本研究的目的是分析这些与胎儿结局相关的参数。
在一所大学医学中心对双胎分娩（n = 1444）进行了大规模回顾性分析。分析包括妊娠、分娩以及母婴参数，包括第一和第二个出生的双胞胎之间的pH值和碱剩余（BE）差异（ΔpH、ΔBE）。
对于子宫内不同位置的双胞胎，ΔpH与出生间隔显著相关（p < 0.05）。出生间隔越长，ΔpH越大，第二个双胞胎的pH值越低。对于头位和臀位双胞胎组合，ΔBE值与出生间隔显著相关。此外，可以表明，第一/第二个双胞胎之间出生体重差异越大，ΔpH越高，ΔBE值越高（所有p < 0.05）。我们发现，与二次剖宫产和最终的一次剖宫产相比，阴道分娩时的ΔpH值显著降低（p < 0.001）。
我们得出结论，如果有经验的工作人员密切监测出生体重差异、出生间隔和血液值，双胎阴道分娩似乎是安全的。如果有经验丰富的工作人员，第二个自然分娩的双胞胎也能有良好的结局。
