Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology and the Department of Newborn & Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Department of Obstetrics and Gynecology, North York General Hospital, Toronto, ON, Canada.
BMC Pregnancy Childbirth. 2020 Nov 17;20(1):702. doi: 10.1186/s12884-020-03369-x.
In the Twin Birth Study, women at 32-38 weeks of gestation, in whom the first twin was in cephalic presentation, were randomized to planned vaginal delivery or cesarean section. The study found no significant differences in neonatal or maternal outcomes in the two planned mode of delivery groups. We aimed to compare neonatal and maternal outcomes of twin gestations without spontaneous onset of labor, who underwent induction of labor or pre-labor cesarean section as the intervention of induction may affect outcomes.
In this secondary analysis of the Twin Birth Study we compared those who had an induction of labor with those who had a pre-labor cesarean section. The primary outcome was a composite of fetal or neonatal death or serious neonatal morbidity. Secondary outcome was a composite of maternal morbidity and mortality.
NCT00187369.
Of the 2804 women included in the Twin Birth Study, a total of 1347 (48%) women required a delivery before a spontaneous onset of labor occurred: 568 (42%) in the planned vaginal delivery arm and 779 (58%) in the planned cesarean arm. Induction of labor was attempted in 409 (30%), and 938 (70%) had a pre-labor cesarean section. The rate of intrapartum cesarean section in the induction of labor group was 41.3%. The rate of the primary outcome was comparable between the pre-labor cesarean section group and induction of labor group (1.65% vs. 1.97%; p = 0.61; OR 0.83; 95% CI 0.43-1.62). The maternal composite outcome was found to be lower with pre-labor cesarean section compared to induction of labor (7.25% vs. 11.25%; p = 0.01; OR 0.61; 95% CI 0.41-0.91).
In women with twin gestation between 32-38 weeks of gestation, induction of labor and pre-labor cesarean section have similar neonatal outcomes. Pre-labor cesarean section is associated with favorable maternal outcomes which differs from the overall Twin Birth Study results. These data may be used to better counsel women with twin gestation who are faced with the decision of interventional delivery.
在双胎分娩研究中，32-38 周妊娠、第一胎儿为头位的孕妇被随机分配至计划阴道分娩或剖宫产。研究发现两组计划分娩方式的新生儿或产妇结局无显著差异。我们旨在比较无自发临产的双胎妊娠孕妇的新生儿和产妇结局，这些孕妇接受引产或产前剖宫产作为干预措施，因为引产可能会影响结局。
本研究为双胎分娩研究的二次分析，比较了引产组与产前剖宫产组。主要结局是胎儿或新生儿死亡或严重新生儿并发症的复合结局。次要结局是产妇发病率和死亡率的复合结局。
NCT00187369。
在双胎分娩研究中，2804 例孕妇中共有 1347 例（48%）需要在自发临产前分娩：计划阴道分娩组 568 例（42%），计划剖宫产组 779 例（58%）。409 例（30%）尝试引产，938 例（70%）行产前剖宫产。引产组的产时剖宫产率为 41.3%。产前剖宫产组和引产组的主要结局发生率相似（1.65%比 1.97%；p=0.61；OR 0.83；95%CI 0.43-1.62）。与引产相比，产前剖宫产组的产妇复合结局发生率较低（7.25%比 11.25%；p=0.01；OR 0.61；95%CI 0.41-0.91）。
在 32-38 周妊娠的双胎孕妇中，引产和产前剖宫产有相似的新生儿结局。产前剖宫产与有利的产妇结局相关，与总体双胎分娩研究结果不同。这些数据可用于更好地为面临干预性分娩决策的双胎妊娠孕妇提供咨询。
