Resident Assistant.
Professor.
Obstet Gynecol Surv. 2020 Jul;75(7):419-430. doi: 10.1097/OGX.0000000000000803.
Twin pregnancies are associated with a higher risk of perinatal mortality and morbidity compared with singleton and require more intensive prenatal care.
The aim of this study was to review and compare the recommendations from published guidelines on twin pregnancies.
A descriptive review of guidelines from the Royal College of Obstetricians and Gynaecologists, the International Society of Ultrasound in Obstetrics and Gynecology, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, the National Institute for Health and Care Excellence, the Institute of Obstetricians and Gynaecologists of the Royal College of Physicians of Ireland, the International Federation of Gynecology and Obstetrics, the Society of Obstetricians and Gynaecologists of Canada, and the American College of Obstetricians and Gynecologists on the management of twin pregnancies was conducted.
All the guidelines highlight the importance of an accurate assessment of chorionicity, amnionicity, and gestational age in the first trimester. They also recommend the performance of nuchal translucency and a detailed anomaly scan. The ultrasound surveillance protocol is similar in all guidelines, that is, every 2 weeks for monochorionic and every 4 weeks for dichorionic twins. On the other hand, there are differences regarding the timing and mode of delivery, especially in monochorionic diamniotic twins, in the definition and management of fetal growth discordance, the use of cervical length to screen for preterm birth, and the timing of corticosteroids' administration.
The differences in the reviewed guidelines on the management of twin pregnancies highlight the need for an adoption of an international consensus, in order to improve perinatal outcomes of twin pregnancies.
与单胎妊娠相比，双胎妊娠围产期死亡率和发病率更高，因此需要更密集的产前护理。
本研究旨在回顾和比较发表的双胎妊娠指南中的建议。
对皇家妇产科医师学院、国际妇产科超声学会、澳大利亚和新西兰皇家妇产科医师学院、英国国家卫生与保健卓越研究所、爱尔兰皇家妇产科学院妇产科医师学会、国际妇产科联合会、加拿大妇产科医师学会和美国妇产科医师学会发布的关于双胎妊娠管理的指南进行了描述性综述。
所有指南都强调了在孕早期准确评估绒毛膜性、羊膜性和胎龄的重要性。它们还建议进行颈项透明层和详细的异常扫描。所有指南的超声监测方案都相似，即单绒毛膜双胎每 2 周监测一次，双绒毛膜双胎每 4 周监测一次。另一方面，在分娩时机和方式、尤其是在单绒毛膜双羊膜囊双胎妊娠、胎儿生长不一致的定义和管理、使用宫颈长度筛查早产以及皮质类固醇给药时机方面存在差异。
对双胎妊娠管理的审查指南之间的差异突出表明需要采用国际共识，以改善双胎妊娠的围产期结局。
