Tal Alon, Zafran Noah, Peretz Hadar, Garmi Gali, Romano Shabtai, Salim Raed
Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel.
The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
Eur J Obstet Gynecol Reprod Biol X. 2019 Apr 30;3:100023. doi: 10.1016/j.eurox.2019.100023. eCollection 2019 Jul.
To examine the trend of cesarean delivery (CD) rate among twin pregnancies and the trend in maternal and neonatal morbidities within two decades.
Population-based cohort study, conducted at a single teaching hospital in Israel on data between January 1995 and December 2015. All pregnant women with twin gestation who delivered at a gestational age of 24 weeks or more were included. Data on mode of deliveries, Apgar score <7 at 5 min, cord artery pH < 7.1, early postpartum hemorrhage, blood transfusion, and intrapartum fever for each year were extracted and plotted, and trends were analyzed. CDs performed for one or both twins were divided to laboring, i.e., after a trial of labor, and non-laboring CDs. Data was obtained from the hospital discharge register with ICD-9 codes and crosschecked with the labor medical records. The Cochran-Armitage Trend Test was used to identify trends and correlations.
Of all 88,145 deliveries that took place during this period, 1955 (2.2%) were twins. Of these 53 were ineligible and were excluded. There was a statistically significant trend (increase) in twins birth over time (p = 0.004). CD rate increased significantly from 43.4% in 1995 to 66.0% in 2015 (p = 0.001). This increase was observed only among non-laboring cesareans (p = 0.001). Multivariate logistic regression analysis revealed that maternal and early neonatal morbidities examined did not differ significantly during the study period.
Non-laboring CD rate increased significantly over the past two decades among twin pregnancies. Despite this increase, maternal and early neonatal morbidities did not change.
研究双胎妊娠剖宫产率的变化趋势以及二十年内孕产妇和新生儿发病率的变化趋势。
基于人群的队列研究，在以色列一家教学医院进行，研究数据来自1995年1月至2015年12月。纳入所有孕24周及以上分娩的双胎妊娠孕妇。提取并绘制每年的分娩方式、5分钟时阿氏评分<7、脐动脉pH<7.1、产后早期出血、输血和产时发热的数据，并分析趋势。为单胎或双胎实施的剖宫产分为经试产的剖宫产和未经试产的剖宫产。数据从带有国际疾病分类第九版（ICD-9）编码的医院出院登记册中获取，并与分娩病历进行交叉核对。采用 Cochr an-Armitage趋势检验来识别趋势和相关性。
在此期间发生的所有88145例分娩中，1955例（2.2%）为双胎妊娠。其中53例不符合条件被排除。双胎分娩随时间有统计学显著趋势（增加）（p = 0.004）。剖宫产率从1995年的43.4%显著增加到2015年的66.0%（p = 0.001）。这种增加仅在未经试产的剖宫产中观察到（p = 0.001）。多因素逻辑回归分析显示，研究期间所检查的孕产妇和早期新生儿发病率无显著差异。
在过去二十年中，双胎妊娠未经试产的剖宫产率显著增加。尽管如此，孕产妇和早期新生儿发病率并未改变。
