Department of Obstetrics and Gynecology, Sinai Hospital, Baltimore, Maryland; and Maternal Fetal Medicine Associates, PLLC, and the Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York.
Obstet Gynecol. 2021 Sep 1;138(3):348-352. doi: 10.1097/AOG.0000000000004483.
To compare mode of delivery between monochorionic and dichorionic twin pregnancies.
This was a retrospective cohort study of women undergoing delivery of diamniotic twins in a single maternal-fetal medicine practice in New York City between 2005 and 2021. We compared baseline characteristics and delivery outcomes between monochorionic and dichorionic gestations. The primary outcome was mode of delivery. For monochorionic-diamniotic twin pregnancies at or after 34 weeks of gestation, we also compared neonatal outcomes between women who did and did not attempt vaginal delivery. Data were analyzed using the χ2 test, Fisher exact test, and t test when appropriate.
A total of 1,121 diamniotic twin pregnancies were identified, of which 202 (18%) were monochorionic and 919 (82%) were dichorionic. Mode of delivery did not differ between monochorionic and dichorionic pregnancies, both in the overall cohort (cesarean delivery rate 61% vs 63%, P=.54) and in the subgroup of women who attempted vaginal delivery (cesarean delivery rate 22% vs 21%, P=.80). For patients with a vaginal delivery of twin A, the mode of delivery for twin B did not differ between the groups. Among the patients with monochorionic pregnancies at or after 34 weeks of gestation, neonatal outcomes did not differ between women who did and did not attempt vaginal delivery.
Monochorionic-diamniotic pregnancies are not at an increased risk of cesarean delivery when compared with their dichorionic-diamniotic counterparts.
比较单绒毛膜和双绒毛膜双胎的分娩方式。
这是一项回顾性队列研究，纳入了 2005 年至 2021 年期间在纽约市一家母胎医学诊所分娩的双羊膜囊双胎孕妇。我们比较了单绒毛膜和双绒毛膜妊娠的基线特征和分娩结局。主要结局为分娩方式。对于 34 周及以上的单绒毛膜-双羊膜囊双胎妊娠，我们还比较了尝试阴道分娩和未尝试阴道分娩的孕妇的新生儿结局。数据采用 χ2 检验、Fisher 确切检验和 t 检验进行分析。
共纳入 1121 例双羊膜囊双胎妊娠，其中 202 例（18%）为单绒毛膜，919 例（82%）为双绒毛膜。单绒毛膜和双绒毛膜妊娠的分娩方式无差异，总体人群中剖宫产率分别为 61%和 63%（P=0.54），尝试阴道分娩的孕妇中剖宫产率分别为 22%和 21%（P=0.80）。对于阴道分娩第一胎的患者，第二胎的分娩方式在两组间无差异。在 34 周及以上的单绒毛膜妊娠患者中，尝试阴道分娩和未尝试阴道分娩的孕妇新生儿结局无差异。
与双绒毛膜-双羊膜囊双胎妊娠相比，单绒毛膜-双羊膜囊双胎妊娠的剖宫产风险并未增加。
