Tal Alon, Peretz Hadar, Garmi Gali, Zafran Noah, Romano Shabtai, Salim Raed
Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel.
Rappaport Faculty of Medicine, Technion, Haifa, Israel.
Birth. 2018 Mar;45(1):37-42. doi: 10.1111/birt.12317. Epub 2017 Nov 2.
To examine the effect of inter-twin delivery interval on umbilical artery pH and Apgar score of the second twin after vaginal delivery of the first twin.
Retrospective study conducted at a single teaching hospital. All pregnant women with twin gestation who delivered the first twin vaginally at more than 24 weeks between 1995 and 2015 were included. Major malformations and intrauterine deaths of one or both twins were excluded. Women were divided into those who had an inter-twin delivery interval of less than 30 minutes (group 1) or 30 minutes or more (group 2). Primary outcome was umbilical artery pH less than 7.1 and/or Apgar score less than 7 at 5 minutes of the second twin. Generalized linear regression with log was performed to evaluate the association with delivery interval.
Of 88 145 deliveries during this period, 1955 (2.2%) were twins. Overall, 713 twin pregnancies, 596 (83.6%) in group 1 and 117 (16.4%) in group 2, were eligible and included. Mean inter-delivery interval was 11.0 ± 6.5 and 52.5 ± 31.5 minutes in groups 1 and 2, respectively. After adjusting for variables found significantly different between the groups in univariate analysis, inter-delivery interval of less than 30 minutes or 30 minutes or more was not a significant risk factor for pH less than 7.1 and/or Apgar less than 7 (P = .91). The cesarean rate for delivery of the second twin after vaginal delivery of the first twin was 4.3% overall, with a higher rate among group 2 compared with group 1 (18.2% and 3.2%, respectively; P = .001).
The second twin's Apgar score and cord artery pH are probably not affected when the inter-twin delivery interval exceeds 30 minutes.
探讨单胎经阴道分娩后双胎分娩间隔时间对第二个胎儿脐动脉pH值及阿氏评分的影响。
在一家教学医院进行回顾性研究。纳入1995年至2015年间孕周超过24周且第一个胎儿经阴道分娩的所有双胎妊娠孕妇。排除一个或两个胎儿有严重畸形及宫内死亡的情况。将孕妇分为双胎分娩间隔时间小于30分钟的组（第1组）和30分钟及以上的组（第2组）。主要结局指标为第二个胎儿出生后5分钟时脐动脉pH值小于7.1和/或阿氏评分小于7。采用对数广义线性回归分析评估与分娩间隔时间的相关性。
在此期间的88145例分娩中，1955例（2.2%）为双胎妊娠。总体而言，713例双胎妊娠符合纳入标准并被纳入研究，其中第1组596例（83.6%），第2组117例（16.4%）。第1组和第2组的平均分娩间隔时间分别为11.0±6.5分钟和52.5±31.5分钟。在对单因素分析中两组间存在显著差异的变量进行校正后，分娩间隔时间小于30分钟或30分钟及以上并非脐动脉pH值小于7.1和/或阿氏评分小于7的显著危险因素（P = 0.91）。第一个胎儿经阴道分娩后第二个胎儿的剖宫产率总体为4.3%，第2组高于第1组（分别为18.2%和3.2%；P = 0.001）。
当双胎分娩间隔时间超过30分钟时，第二个胎儿的阿氏评分及脐动脉pH值可能不受影响。
