Dathan-Stumpf Anne, Winkel Katharina, Stepan Holger
University Hospital Leipzig, Department of Obstetrics, Leipzig, Germany.
University Leipzig, Leipzig, Germany.
Geburtshilfe Frauenheilkd. 2020 Oct;80(10):1033-1040. doi: 10.1055/a-1181-8737. Epub 2020 Jun 18.
The appropriate delivery mode for twins is discussed controversially in the literature. The aim of this study was to investigate delivery modes and short-term neonatal outcomes of twin pregnancies delivered in University Hospital Leipzig. A total of 274 twin pregnancies (32.0 to 39.4 weeks of gestation) delivered between 2015 and 2017 were analyzed retrospectively with regard to the planned and final delivery mode as well as neonatal outcomes. The inclusion and exclusion criteria for vaginal delivery were comparable to those of the Twin Birth Study. The spontaneous birth rate for births planned as vaginal deliveries was 78.5%; the rate of secondary cesarean section was 19.4%. The final total cesarean rate was 58.8%, and the rate of vaginal deliveries was 41.2%. Vertex or non-vertex position of the second twin had no significant effect on neonatal outcome or mean delivery interval between the birth of the first and second twin. Chorionicity, neonatal weight and gender had no significant impact on delivery mode. However, successful vaginal delivery was associated with higher gestational age and both fetuses in vertex position. The combined neonatal outcome for both twins was significantly worse if they were delivered by cesarean section compared to spontaneous birth. In addition, the leading twin in monochorionic/diamniotic (MC/DA) pregnancies was intubated more frequently after cesarean delivery and had significantly lower Apgar scores. Vaginal delivery in twin pregnancies is a practicable and safe option in specific defined conditions and when the appropriate infrastructure and clinical experience is available.
文献中对双胎妊娠合适的分娩方式存在争议性讨论。本研究的目的是调查在莱比锡大学医院分娩的双胎妊娠的分娩方式及新生儿短期结局。回顾性分析了2015年至2017年间分娩的274例双胎妊娠（妊娠32.0至39.4周），内容包括计划和最终的分娩方式以及新生儿结局。阴道分娩的纳入和排除标准与双胎出生研究的标准相当。计划阴道分娩的自然分娩率为78.5%；二次剖宫产率为19.4%。最终的总剖宫产率为58.8%，阴道分娩率为41.2%。第二个胎儿的胎位为头位或非头位对新生儿结局或第一个和第二个胎儿出生之间的平均分娩间隔无显著影响。绒毛膜性、新生儿体重和性别对分娩方式无显著影响。然而，成功的阴道分娩与较高的孕周以及两个胎儿均为头位有关。与自然分娩相比，剖宫产分娩的双胎的综合新生儿结局明显更差。此外，单绒毛膜双羊膜囊（MC/DA）妊娠中的主导胎儿在剖宫产后更频繁地需要插管，且阿氏评分显著更低。在特定的限定条件下以及具备适当的基础设施和临床经验时，双胎妊娠的阴道分娩是一种可行且安全的选择。
