Harvard Medical School, Boston, Massachusetts, USA
Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.
BMJ Open. 2021 Oct 21;11(10):e047553. doi: 10.1136/bmjopen-2020-047553.
This study aims to evaluate the prevalence and outcome of twin pregnancies in Botswana.
The Tsepamo Study conducted birth outcomes surveillance at 8 government-run hospitals (45% of all births in Botswana) from August 2014 to June 2018 and expanded to 18 hospitals (70% of all births in Botswana) from July 2018 to March 2019.
Data were collected for all live-born and stillborn in-hospital deliveries with a gestational age (GA) greater than 24 weeks. This analysis included 117 593 singleton and 3718 twin infants (1859 sets (1.6%)) born to 119 477 women between August 2014 and March 2019 and excluded 73 higher order multiples (23 sets of triplets and 1 set of quadruplets).
Our primary outcomes were preterm delivery (<37 weeks GA), very preterm delivery (<32 weeks GA) and stillbirth (APGAR (Appearance, Pulse, Grimace, Activity, Respiration) score of 0, 0, 0).
Women with twin pregnancies had a similar median number of antenatal care visits (9 vs 10), but were more likely to deliver in a tertiary centre (54.8% vs 45.1%, p<0.001) and more likely to have a cesarean-section (54.6% vs 22.0%, p<0.001) than women with singletons. Compared with singletons, twin pregnancies had a higher risk of preterm delivery (<37 weeks GA) (47.6% vs 16.7%, adjusted risk ratio (aRR) 2.8, 95% CI 2.7 to 2.9) and very preterm delivery (<32 weeks) (11.8% vs 4.0%, aRR 3.0 95% CI 2.6 to 3.4). Among all twin pregnancies, 128 (6.9%) had at least one stillborn infant compared with 2845 (2.4%) stillbirths among singletons (aRR 2.8, 95% CI 2.3 to 3.3).
Adverse birth outcomes are common among twins in Botswana, and are often severe. Interventions that allow for earlier identification of twin gestation and improved antenatal management of twin pregnancies may improve infant and child survival.
本研究旨在评估博茨瓦纳双胞胎妊娠的流行情况和结局。
Tsepamo 研究于 2014 年 8 月至 2018 年 6 月在 8 家政府运营的医院（博茨瓦纳所有分娩的约 45%）进行了出生结局监测，并于 2018 年 7 月至 2019 年 3 月扩大到 18 家医院（博茨瓦纳所有分娩的约 70%）。
本研究纳入了 2014 年 8 月至 2019 年 3 月期间在医院分娩的所有 24 周以上胎龄（GA）的活产儿和死产儿。该分析包括了 117593 例单胎和 3718 例双胎（1859 对（1.6%））婴儿，共来自 119477 名女性，排除了 73 例多胎妊娠（23 对三胞胎和 1 例四胞胎）。
我们的主要结局是早产（<37 周 GA）、极早产（<32 周 GA）和死产（新生儿阿普加评分（Appearance, Pulse, Grimace, Activity, Respiration）为 0、0、0）。
双胎妊娠的女性产前检查次数中位数相似（9 次与 10 次），但更有可能在三级中心分娩（54.8%与 45.1%，p<0.001），剖宫产率更高（54.6%与 22.0%，p<0.001）。与单胎妊娠相比，双胎妊娠早产（<37 周 GA）的风险更高（47.6%与 16.7%，校正风险比（aRR）2.8，95%CI 2.7 至 2.9）和极早产（<32 周）的风险更高（11.8%与 4.0%，aRR 3.0，95%CI 2.6 至 3.4）。在所有双胎妊娠中，有 128 例（6.9%）至少有 1 例死产儿，而单胎妊娠中 2845 例（2.4%）死产（aRR 2.8，95%CI 2.3 至 3.3）。
博茨瓦纳的双胞胎妊娠不良结局常见，且往往较为严重。通过早期识别双胎妊娠并改善双胎妊娠的产前管理，可能改善婴儿和儿童的生存率。
