Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Arch Gynecol Obstet. 2022 Jul;306(1):93-100. doi: 10.1007/s00404-021-06272-8. Epub 2021 Oct 2.
To compare perinatal outcomes following induction of labor in dichorionic versus monochorionic twin pregnancies.
A retrospective cohort study analyzing all women with twin pregnancies who underwent induction of labor in a single university-affiliated tertiary medical center. The cohort included 290 women who were divided into 2 groups according to chorionicity: (1) dichorionic twin pregnancies (n = 203); (2) monochorionic twin pregnancies (n = 87). Induction of labor methods included oxytocin infusion, extra-amniotic balloon catheter and artificial amniotomy. Primary outcome was defined as mode of delivery. Secondary outcomes included maternal and neonatal adverse events.
Primary outcome did not differ between groups, with vaginal delivery rate of 92.1% in the dichorionic group and 94.2% in the monochorionic group. Women with dichorionic twins delivered later compared to monochorionic twins (38.00 weeks vs. 36.43 weeks, respectively, p < 0.001). While no differences were observed in Apgar scores or umbilical cord pH measurements, dichorionic twins were less frequently admitted to the neonatal intensive care unit compared to monochorionic twins (2.4% vs. 3.4%, p = 0.01 for 1st twin; and 6.9% vs. 10.3%, p = 0.089 for 2nd twin). Multivariate logistic regression adjusting outcomes to potential confounders, found gestational age at delivery to be the only variable significantly associated with neonatal intensive care unit admission rates (odds ratio 0.236, 95% confidence interval 0.152-0.366, p < 0.001).
Labor induction might be considered for both di- and monochorionic uncomplicated twin pregnancies with excellent vaginal delivery rates. The higher rates of neonatal adverse outcomes among monochorionic twins are presumably related to earlier gestation age at delivery.
比较双绒毛膜与单绒毛膜双胎妊娠引产的围产结局。
本研究采用回顾性队列研究，分析了在一家大学附属的三级医疗中心接受引产的所有双胎妊娠妇女。该队列纳入了 290 名孕妇，根据绒毛膜性分为两组：（1）双绒毛膜双胎妊娠（n=203）；（2）单绒毛膜双胎妊娠（n=87）。引产方法包括催产素输注、羊膜外球囊导管和人工破膜。主要结局定义为分娩方式。次要结局包括母婴不良事件。
两组主要结局无差异，双绒毛膜组阴道分娩率为 92.1%，单绒毛膜组为 94.2%。双绒毛膜组孕妇分娩时间晚于单绒毛膜组（分别为 38.00 周和 36.43 周，p<0.001）。两组新生儿的 Apgar 评分和脐动脉血 pH 值无差异，但双绒毛膜组较单绒毛膜组新生儿入住新生儿重症监护病房的比例低（第一胎分别为 2.4%和 3.4%，p=0.01；第二胎分别为 6.9%和 10.3%，p=0.089）。调整潜在混杂因素后的多变量逻辑回归发现，分娩时的胎龄是唯一与新生儿重症监护病房入住率显著相关的变量（优势比 0.236，95%置信区间 0.152-0.366，p<0.001）。
对于无并发症的双绒毛膜和单绒毛膜双胎妊娠，均可以考虑引产，阴道分娩率均较高。单绒毛膜双胎妊娠新生儿不良结局发生率较高，可能与分娩时的胎龄更早有关。
