Algeri Paola, Callegari Clelia, Mastrolia Salvatore Andrea, Brienza Letizia, Vaglio Tessitore Isadora, Paterlini Giuseppe, Incerti Maddalena, Cozzolino Sabrina, Vergani Patrizia
a Department of Maternal Fetal Medicine, Fondazione MBBM, San Gerardo Hospital , University of Milano Bicocca , Monza , Italy.
b Neonatal Intensive Care Unit, Fondazione MBBM, San Gerardo Hospital , University of Milano Bicocca , Monza , Italy.
J Matern Fetal Neonatal Med. 2019 Oct;32(20):3480-3486. doi: 10.1080/14767058.2018.1481036. Epub 2018 Jun 21.
Optimal management of twin deliveries is controversial. We aimed to assess if intertwin delivery interval, after vaginal delivery of the first twin, may have an influence on adverse neonatal outcomes of the second twin This is a retrospective observational study including diamniotic twin pregnancies with vaginal delivery of the first twin, between January 2000 and July 2017. Inclusion criteria were diamniotic pregnancies and vaginal delivery of the first twin. We excluded higher twin order, monoamniotic pregnancies, cesarean delivery of the first twin and patients with missing data. A number of 400 diamniotic twin pregnancies met the inclusion criteria and were divided, considering intertwin delivery interval into (1) ≤30 minutes ( = 365); and (2) >30 minutes ( = 35). Considering the two study groups, maternal and first twin characteristics and outcomes were similar. Second twin reported higher incidence of cesarean section and vacuum delivery, but similar incidence of neonatal adverse outcomes, in case of intertwin interval >30 minutes. At multivariate analysis, a difference between second and first twin weight ≥25% was correlated to neonatal adverse outcome, while we did not found this correlation with a cut-off of 30 minutes. In our study, growth discrepancy between twins was significantly correlated to adverse neonatal outcomes, while intertwin delivery time was not an influencing factor. So, in line with this result, in our clinical practice, we do not use a fixed time in which both twins should be delivered, neither in monochorionic nor in dichorionic pregnancies, when fetal wellbeing was demonstrated during labor.
双胎分娩的最佳管理存在争议。我们旨在评估在经阴道分娩第一个双胎后,双胎分娩间隔是否会对第二个双胎的不良新生儿结局产生影响。这是一项回顾性观察性研究,纳入了2000年1月至2017年7月期间经阴道分娩第一个双胎的双羊膜囊双胎妊娠。纳入标准为双羊膜囊妊娠且第一个双胎经阴道分娩。我们排除了更高胎次的双胎、单羊膜囊妊娠、第一个双胎剖宫产以及数据缺失的患者。400例双羊膜囊双胎妊娠符合纳入标准,并根据双胎分娩间隔分为:(1)≤30分钟(n = 365);(2)>30分钟(n = 35)。考虑到两个研究组,母亲和第一个双胎的特征及结局相似。在双胎间隔>30分钟的情况下,第二个双胎剖宫产和真空助产的发生率较高,但新生儿不良结局的发生率相似。多因素分析显示,第二个双胎与第一个双胎体重差异≥25%与新生儿不良结局相关,而我们未发现与30分钟的临界值存在这种相关性。在我们的研究中,双胎之间的生长差异与新生儿不良结局显著相关,而双胎分娩时间不是一个影响因素。因此,根据这一结果,在我们的临床实践中,当产程中胎儿状况良好时,无论是单绒毛膜还是双绒毛膜妊娠,我们都不会采用固定的时间来分娩两个双胎。