Bibbo Carolina, Easter Sarah R, Saadeh Michael, Little Sarah E, Robinson Julian N
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts.
AJP Rep. 2019 Apr;9(2):e153-e159. doi: 10.1055/s-0039-1687872. Epub 2019 Apr 30.
This study was aimed to determine if different strategies of antenatal corticosteroid (ACS) administration in monoamniotic twins leads to receipt within 7 days of delivery. This is a retrospective cohort of monoamniotic twins managed at a single institution from 2007 to 2017. Patients were classified as to whether ACS were administered upon admission or at a predetermined gestational age (grouped together as "routine") or for a change in clinical status ("indicated"). We used univariate analyses to associate ACS administration strategies with our primary outcome: receipt of ACS within 7 days of delivery. We then used generalized estimating equations to examine associations between fetal monitoring patterns and delivery within 1 week. Twenty-four patients were included: eighteen patients in the "routine" group and six patients in the "indicated" group. There was no difference in optimal timing of ACS administration. Women experiencing delivery within the week were thrice more likely to spend on average more than 3 hours/day on the fetal monitor when compared with those who remained undelivered. Administration of ACS on admission is not effective. Fetal heart rate tracing surveillance might be a better methodology to predict delivery and guide ACS administration.
本研究旨在确定单绒毛膜单羊膜囊双胎妊娠中不同的产前糖皮质激素（ACS）给药策略是否能使药物在分娩前7天内使用。 这是一项对2007年至2017年在单一机构管理的单绒毛膜单羊膜囊双胎妊娠进行的回顾性队列研究。患者根据入院时或预定孕周时是否给予ACS（归为“常规”组）或因临床状况改变而给予ACS（“指征性”组）进行分类。我们采用单因素分析将ACS给药策略与主要结局相关联：分娩前7天内使用ACS。然后我们使用广义估计方程来检验胎儿监测模式与1周内分娩之间的关联。 纳入了24例患者：“常规”组18例患者，“指征性”组6例患者。ACS给药的最佳时机没有差异。与未分娩的患者相比，在一周内分娩的女性平均每天在胎儿监护仪上花费超过3小时的可能性是其3倍。 入院时给予ACS无效。胎儿心率监测可能是预测分娩和指导ACS给药的更好方法。
