Obstetrics and Gynecology Unit, Mother-Infant and Adult Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo 71, 41125, Modena, Italy.
Department of Biomedical, Metabolic and Neural Sciences, International Doctorate School in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41125, Modena, Italy.
Ital J Pediatr. 2022 Jun 16;48(1):101. doi: 10.1186/s13052-022-01297-4.
Multiple gestations represent a considerable proportion of pregnancies delivering in the late preterm (LP) period. Only 30% of LP twins are due to spontaneous preterm labor and 70% are medically indicated; among this literature described that 16-50% of indicated LP twin deliveries are non-evidence based. As non-evidence-based delivery indications account for iatrogenic morbidity that could be prevented, the objective of our observational study is to investigate first neonatal outcomes of LP twin pregnancies according to gestational age at delivery, chorionicity and delivery indication, then non evidence-based delivery indications.
Prospective cohort study among twins infants born between 34 + 0 and 36 + 6 weeks, in Emilia Romagna, Italy, during 2013-2015. The primary outcome was a composite of adverse perinatal outcomes.
Among 346 LP twins, 84 (23.4%) were monochorionic and 262 (75.7%) were dichorionic; spontaneous preterm labor accounted for 85 (24.6%) deliveries, preterm prelabor rupture of membranes for 66 (19.1%), evidence based indicated deliveries were 117 (33.8%), while non-evidence-based indications were 78 (22.5%). When compared to spontaneous preterm labor or preterm prelabor rupture of membranes, pregnancies delivered due to maternal and/or fetal indications were associated with higher maternal age (p < 0.01), higher gestational age at delivery (p < 0.01), Caucasian race (p 0.04), ART use (p < 0.01), gestational diabetes (p < 0.01), vaginal bleeding (p < 0.01), antenatal corticosteroids (p < 0.01), diagnosis of fetal growth restriction (FGR) (p < 0.01), and monochorionic (p < 0.01). Two hundred twenty-six pregnancies (65.3%) had at least one fetus experiencing one composite of adverse perinatal outcome. Multivariate analysis confirmed that delivery indication did not affect the composite of adverse perinatal outcomes; the only characteristic that affect the outcome after controlling for confounding was gestational age at delivery (p < 0.01). Moreover, there was at least one adverse neonatal outcome for 94% of babies born at 34 weeks, for 73% of those born at 35 weeks and for 46% of those born at 36 weeks (p < 0.01).
Our study suggests that the decision to deliver or not twins in LP period should consider gestational age at delivery as the main determinant infants' prognosis. Delivery indications should be accurately considered, to avoid iatrogenic early birth responsible of preventable complications.
多胎妊娠在晚期早产（LP）期间占相当大的比例。只有 30%的 LP 双胞胎是自发性早产，70%是医学指征；其中文献描述，16-50%的有指征的 LP 双胞胎分娩是非基于证据的。由于非基于证据的分娩指征会导致可预防的医源性发病率，我们的观察性研究的目的是根据分娩时的胎龄、绒毛膜性和分娩指征，首先调查 LP 双胞胎妊娠的新生儿结局，然后调查非基于证据的分娩指征。
在意大利艾米利亚-罗马涅地区，2013 年至 2015 年期间，对 34+0 至 36+6 周之间出生的双胞胎婴儿进行前瞻性队列研究。主要结局是围产期不良结局的复合结局。
在 346 例 LP 双胞胎中，84 例（23.4%）为单绒毛膜性，262 例（75.7%）为双绒毛膜性；自发性早产临产占 85 例（24.6%），胎膜早破早产临产占 66 例（19.1%），基于证据的有指征分娩占 117 例（33.8%），而非基于证据的有指征分娩占 78 例（22.5%）。与自发性早产临产或胎膜早破早产临产相比，因母亲和/或胎儿指征而分娩的妊娠与较高的母亲年龄（p<0.01）、较高的分娩时胎龄（p<0.01）、白种人种族（p<0.04）、ART 应用（p<0.01）、妊娠期糖尿病（p<0.01）、阴道出血（p<0.01）、产前皮质激素（p<0.01）、胎儿生长受限（FGR）的诊断（p<0.01）和单绒毛膜性（p<0.01）有关。226 例妊娠（65.3%）至少有一个胎儿出现一种围产期不良复合结局。多变量分析证实，分娩指征并不影响围产期不良结局的复合结局；在控制混杂因素后，唯一影响结局的特征是分娩时的胎龄（p<0.01）。此外，34 周出生的婴儿中，94%至少有一个新生儿不良结局，35 周出生的婴儿中，73%至少有一个新生儿不良结局，36 周出生的婴儿中，46%至少有一个新生儿不良结局（p<0.01）。
我们的研究表明，在 LP 期间决定是否分娩双胞胎应考虑分娩时的胎龄作为婴儿预后的主要决定因素。应准确考虑分娩指征，以避免导致可预防并发症的医源性早产。
