Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem.
Department of Neonatology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Acta Obstet Gynecol Scand. 2018 Jul;97(7):845-851. doi: 10.1111/aogs.13333. Epub 2018 Mar 25.
Twin vaginal delivery presents a unique clinical challenge for obstetricians. The Twin Birth Study demonstrated the safety of planned vaginal delivery regarding neonatal outcomes. However, that study lacked a description of the risk factors associated with and the outcome of unplanned cesarean section. The aim of this study is to identify potential risk factors for cesarean section and delivery related neonatal morbidity and mortality in women with twin pregnancy attempting vaginal delivery.
A retrospective cohort study including 1070 women with twin pregnancy that underwent a trial of labor between 2003 and 2015. The study population was divided according to the mode of delivery: vaginal delivery, combined vaginal-cesarean and intrapartum cesarean delivery of both twins. Several risk factors and neonatal outcomes were examined by both univariate analysis and multinomial logistic regression analysis.
The rate of vaginal delivery of both twins was 88.3%, whereas the rates of combined vaginal cesarean and unplanned cesarean delivery were 4.6% and 7.1%, respectively. Nulliparity and nonvertex presentation of twin B were found to be independently associated with cesarean delivery for both twins. Additionally, nonvertex presentation of twin B was independently associated with combined vaginal-cesarean delivery. The proportion of neonates with Apgar score <7 at 5 min was increased for both twins in the combined vaginal-cesarean group compared with those delivered by the vaginal route alone.
Nulliparity and nonvertex presentation of twin B were found to be associated with intrapartum cesarean delivery in twin pregnancies.
双胎阴道分娩对产科医生来说是一个独特的临床挑战。双胞胎分娩研究表明，计划性阴道分娩在新生儿结局方面是安全的。然而，该研究缺乏对无计划剖宫产相关风险因素以及结局的描述。本研究旨在确定尝试阴道分娩的双胎妊娠孕妇行剖宫产术的潜在风险因素以及与分娩相关的新生儿发病率和死亡率。
本研究为回顾性队列研究，纳入了 2003 年至 2015 年间进行试产的 1070 例双胎妊娠孕妇。根据分娩方式将研究人群分为：阴道分娩组、阴道-剖宫产联合分娩组和双胎阴道内剖宫产分娩组。通过单因素分析和多项逻辑回归分析比较了两组间的各种风险因素和新生儿结局。
双胎阴道分娩率为 88.3%，阴道-剖宫产联合分娩率和双胎阴道内剖宫产分娩率分别为 4.6%和 7.1%。初产妇和双胎 B 为非头位是双胎行剖宫产术的独立危险因素。此外，双胎 B 为非头位是行阴道-剖宫产联合分娩的独立危险因素。双胎阴道-剖宫产联合分娩组的新生儿在 5 分钟时 Apgar 评分<7 的比例高于单纯阴道分娩组。
初产妇和双胎 B 为非头位与双胎妊娠的产时剖宫产相关。
