Farghali Mohamed, Abdelazim Ibrahim, Abdelrazek Khaled
a Department of Obstetrics and Gynecology , Faculty of Medicine, Ain Shams University , Cairo , Egypt.
J Matern Fetal Neonatal Med. 2019 May;32(10):1626-1632. doi: 10.1080/14767058.2017.1413547. Epub 2017 Dec 12.
An increasing number of reports describe the delayed second twin delivery for days, or weeks with good results in the majority of the cases, and different survival rate between centers, without reported randomized controlled trials (RCTs).
This study was designed to evaluate the suggested management of the delayed second twin delivery in the Sabah Maternity Hospital regarding its outcome, possible risks, and benefits.
Forty-seven twin pregnancies with preterm labor (PTL) of the first fetus between 20-30 weeks, and delayed delivery of the second twin were included in this study. Studied women signed informed consent about the possible risks of keeping the live fetus in the hostile intrauterine environment, and benefits of the prolonged gestation for the second twin. Throughout the conservative treatment of the second twin, the studied women were hospitalized with regular follow up for infections, consumptive coagulopathy parameters, and wellbeing of the second twin.
There was significant difference in the gestational age at delivery between the first and second twin (22.6 ± 3.4 versus 34.3 ± 2.5 weeks; respectively, p = .01). There was significant difference in the birth weight between the first and second twin (435 ± 91.2 versus 1472 ± 61.5 g; respectively, p = .004). The rate of the cesarean delivery was significantly high during delivery of the second twin compared with the first twin (23.4% (11/47) versus 0% (0/47); respectively, p = .0001) with high survival rate for the second twin (85.1% (40/47)) after the delayed second twin delivery.
The birth weight, the gestational age, and the survival rate of the studied second twin significantly increased after the suggested management of the delayed second twin delivery.
越来越多的报告描述了第二胎延迟数天或数周分娩的情况，大多数病例结果良好，且不同中心的存活率有所差异，但尚无随机对照试验（RCT）的报道。
本研究旨在评估沙巴妇产医院对延迟第二胎分娩的建议管理措施，包括其结局、可能的风险和益处。
本研究纳入了47例双胎妊娠，其中第一胎儿在20 - 30周发生早产（PTL）且第二胎延迟分娩。研究对象签署了知情同意书，了解在不利的子宫内环境中保留存活胎儿的可能风险以及第二胎延长孕周的益处。在对第二胎进行保守治疗期间，研究对象住院并定期随访感染情况、消耗性凝血病参数以及第二胎的健康状况。
第一胎和第二胎的分娩孕周存在显著差异（分别为22.6 ± 3.4周和34.3 ± 2.5周；p = 0.01）。第一胎和第二胎的出生体重存在显著差异（分别为435 ± 91.2克和1472 ± 61.5克；p = 0.004）。与第一胎相比，第二胎分娩时剖宫产率显著较高（分别为23.4%（11/47）和0%（0/47）；p = 0.0001），延迟第二胎分娩后第二胎的存活率较高（85.1%（40/47））。
在对延迟第二胎分娩采取建议的管理措施后，研究中第二胎的出生体重、孕周和存活率显著提高。
