Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland.
Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Acta Obstet Gynecol Scand. 2020 Nov;99(11):1504-1510. doi: 10.1111/aogs.13916. Epub 2020 May 30.
Twin trial of labor presents a challenge to obstetricians, as it is associated with a greater number of adverse birth outcomes compared with singleton deliveries. The risk of poor outcome has shown to be highest with unsuccessful vaginal twin delivery. The purpose of this study was to identify the clinical risk factors associated with intrapartum cesarean section in late preterm and term twin births.
All live diamniotic twin deliveries of at least 35 weeks of gestation with planned vaginal delivery were included in this retrospective single-center cohort study. Maternal and newborn characteristics were compared between a vaginal delivery group and an intrapartum cesarean section group. Logistic regression analysis was carried out to determine independent risk factors of intrapartum cesarean section. Further, maternal and neonatal outcomes were compared between groups of vaginal delivery and cesarean section for both twins and also between groups of vaginal delivery and cesarean section for the second twin only (combined delivery). The impact of presentation of the second twin on the mode of twin delivery and on neonatal outcome was also examined.
Among 821 twin pregnancies, 581 mothers (70.8%) attempted trial of labor and were eligible for the study. With a cephalic-presenting first twin, the trial of labor rate was 89.3% and vaginal delivery was successful in 82.8%. Nulliparity (odds ratio [OR] 3.2, 95% confidence interval [CI] 2.0-5.1) and non-cephalic presentation of the second twin (OR 3.0, 95% CI 1.9-4.8) were found to be independent risk factors of cesarean section. However, 76.1% of mothers with non-cephalic second twins achieved vaginal delivery and perinatal outcomes were comparable with cases of cephalic-presenting second twins. When comparing delivery modes, maternal outcomes were more favorable with vaginal delivery, whereas combined delivery increased the second twin's risk of adverse neonatal outcome.
This study, with high rates of trial of labor and successful vaginal twin delivery, found nulliparity and non-cephalic presentation of the second twin to be risk factors of intrapartum cesarean section in twin pregnancies.
与单胎分娩相比，双胎试产对产科医生来说是一个挑战，因为它与更多不良分娩结局相关。不成功的阴道双胎分娩显示出最高的不良结局风险。本研究的目的是确定与晚期早产和足月双胎分娩产时剖宫产相关的临床危险因素。
本回顾性单中心队列研究纳入了所有至少 35 孕周且计划行阴道分娩的活双胎羊膜囊分娩。比较阴道分娩组和产时剖宫产组的产妇和新生儿特征。进行逻辑回归分析以确定产时剖宫产的独立危险因素。进一步比较两组的阴道分娩和剖宫产的母婴结局，以及两组的阴道分娩和剖宫产仅用于第二胎（联合分娩）的母婴结局。还检查了第二胎的胎位对双胎分娩方式和新生儿结局的影响。
在 821 例双胎妊娠中，581 例母亲（70.8%）尝试试产并符合研究条件。对于头位的第一胎，试产率为 89.3%，阴道分娩成功率为 82.8%。初产妇（比值比 [OR] 3.2，95%置信区间 [CI] 2.0-5.1）和第二胎非头位（OR 3.0，95% CI 1.9-4.8）是剖宫产的独立危险因素。然而，76.1%的第二胎非头位母亲实现了阴道分娩，围产儿结局与头位第二胎相似。当比较分娩方式时，阴道分娩的母婴结局更有利，而联合分娩增加了第二胎不良新生儿结局的风险。
本研究中，试产率和阴道分娩双胎成功率较高，发现初产妇和第二胎非头位是双胎妊娠产时剖宫产的危险因素。
