Kashani-Ligumsky Lior, Cohen Ronnie, Many Ariel, Elmalech Avshalom, Neiger Ran, Lopian Miriam
Department of Obstetrics and Gynecology, Mayanei Hayeshua Medical Center, Bnei Brak, Israel.
Department of Obstetrics and Gynecology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Am J Perinatol. 2024 May;41(S 01):e1486-e1490. doi: 10.1055/a-2051-4284. Epub 2023 Mar 9.
Twin gestations are associated with an increased risk of obstetric and perinatal complications. We studied the association between parity and the rate of maternal and neonatal complications in twins deliveries.
We performed a retrospective analysis of a cohort of twin gestations delivered between 2012 and 2018. Inclusion criteria consisted of twin gestation with two nonanomalous live fetuses at ≥24 weeks' gestation and no contraindications to vaginal delivery. Women were divided into three groups based on parity: primiparas, multiparas (parity of 1-4), and grand multiparas (parity ≥5). Demographic data were collected from electronic patient records and included maternal age, parity, gestational age at delivery, need for induction of labor, and neonatal birth weight. The primary outcome was mode of delivery. Secondary outcomes were maternal and fetal complications.
The study population included 555 twin gestations. One hundred and three were primiparas, 312 were multiparas, and 140 were grand multiparas. Sixty-seven (65%) primiparas delivered the first twin vaginally, as did 294 (94%) multiparas and 133 (95%) grand multiparas ( <0.05). Thirteen (2.3%) women required delivery of the second twin by cesarean section. Among those who delivered both twins vaginally, there was no significant difference in the average time interval between the delivery of the first and the second twins between the groups. The need for transfusion of blood products was higher in the primiparous group compared with the other two groups (11.6 vs. 2.5 and 2.8%, < 0.05). The rate of adverse maternal composite outcomes was higher among primiparous women compared with multiparous and grand multiparous (12.6, 3.2, and 2.8%, respectively, < 0.05). The gestational age at delivery was earlier in the primiparous group compared with the other two groups, and the rate of preterm labor at <34 weeks' gestation was higher among the primiparas. The rate of second twin's 5-minute Apgar's score <7 and the composite adverse neonatal outcome among the primiparous group were significantly higher than the multiparous and grand multiparous groups.
Our study demonstrates that there is an association between high-parity and good obstetric outcomes in twin pregnancies; high parity seems to serve as a protective, rather than a risk factor for adverse maternal and neonatal outcomes.
· There is an association between high-parity and good obstetric outcome in twin pregnancies.. · High parity serves as a protective factor for adverse maternal outcomes in twin deliveries.. · High parity serves as a protective factor for adverse neonatal outcomes in twin deliveries..
双胎妊娠与产科及围产期并发症风险增加相关。我们研究了产次与双胎分娩中孕产妇及新生儿并发症发生率之间的关联。
我们对2012年至2018年间分娩的双胎妊娠队列进行了回顾性分析。纳入标准包括孕龄≥24周的双胎妊娠且两个胎儿均无异常、存活，且无阴道分娩禁忌证。根据产次将女性分为三组：初产妇、经产妇（产次为1 - 4次）和多产妇（产次≥5次）。从电子病历中收集人口统计学数据，包括产妇年龄、产次、分娩时的孕周、引产需求及新生儿出生体重。主要结局为分娩方式。次要结局为孕产妇和胎儿并发症。
研究人群包括555例双胎妊娠。103例为初产妇，312例为经产妇，140例为多产妇。67例（65%）初产妇经阴道分娩第一胎，294例（94%）经产妇和133例（95%）多产妇也是如此（P<0.05）。13例（2.3%）女性需要剖宫产分娩第二胎。在经阴道分娩两胎的女性中，各组第一胎和第二胎分娩的平均时间间隔无显著差异。与其他两组相比，初产妇组输血制品的需求更高（11.6%对2.5%和2.8%，P<0.05）。初产妇中不良孕产妇综合结局的发生率高于经产妇和多产妇（分别为12.6%、3.2%和2.8%，P<0.05）。与其他两组相比，初产妇组的分娩孕周更早，孕34周前早产的发生率更高。初产妇组第二胎5分钟Apgar评分<7分及新生儿综合不良结局的发生率显著高于经产妇和多产妇组。
我们的研究表明，双胎妊娠中高产次与良好的产科结局相关；高产次似乎是孕产妇和新生儿不良结局的保护因素，而非危险因素。
·双胎妊娠中高产次与良好的产科结局相关。·高产次是双胎分娩中孕产妇不良结局 的保护因素。·高产次是双胎分娩中新生儿不良结局的保护因素。
